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Catheter Ablation vs Medication for Atrial Fibrillation
Catheter ablation is indicated for the control of symptoms in patients with atrial fibrillation, but previous comparisons of catheter ablation and antiarrhythmic medication have targeted changes in cardiac rhythm rather than symptomatic improvement. Blomström-Lundqvist and colleagues randomized 155 patients with symptomatic atrial fibrillation who had received treatment with a single antiarrhythmic medication and found that improvement in quality of life at 12 months was greater for patients treated with catheter ablation than for those who tried all available antiarrhythmic drugs.
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Visual Abstract, Summary Video, and CME
Strength of Evidence for Cardiovascular Society Guidelines
Ideally, clinical decisions should be based on evidence from randomized clinical trials. Fanaroff and colleagues reviewed 2930 recommendations from 26 major cardiovascular society guidelines and found that only a small percentage were supported by evidence from randomized trials. In an Editorial, Bonow suggests that clinical guidelines should identify critical gaps in evidence required for optimal patient care.
Dietary Cholesterol and Cardiovascular Disease
The relationship of dietary cholesterol to cardiovascular disease is unclear, and dietary guidelines are ambiguous. Zhong and colleagues pooled individual participant data for 29 615 participants from 6 prospective US cohorts and found that higher consumption of dietary cholesterol or eggs was significantly associated with higher risk of cardiovascular disease and all-cause mortality. In an Editorial, Eckel suggests that the increased risks of dietary cholesterol and egg consumption may be modest for individual patients but are likely to be important at the population level.
Clinical Review & Education
Understanding the Long-term Consequences of an Intervention
In this JAMA Guide to Statistics and Methods, Basu and Maciejewski discuss the choice of an appropriate length of time to study the intended and unintended consequences of interventions in cost-effectiveness and budget impact analyses.
Cardiac Rhythms and Wearable Devices
This JAMA Insights article by Ip discusses the accuracy of direct-to-consumer wearable devices for detecting arrhythmias and emphasizes that signals should not be considered abnormal unless they are confirmed by electrocardiographic testing.
Clinical Management of Atrial Fibrillation
In this JAMA Clinical Guidelines Synopsis of a 2019 guideline developed by the American Heart Association, American College of Cardiology, and Heart Rhythm Society, Beaser and Cifu discuss current options for anticoagulation, interventions to decrease the risk of embolic stroke, and electrophysiologic approaches to convert atrial fibrillation to sinus rhythm.
Author Audio Interview
Highlights. JAMA. 2019;321(11):1021–1023. doi:10.1001/jama.2018.15245
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