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RHYTHM VS. RATE CONTROL STRATEGIES FOR AF

Clinical outcomes in atrial fibrillation (AF) patients are influenced not by the choice of rhythm control versus rate control, but mainly by hospitalisations due to arrhythmia/proarrhythmia and other cardiovascular causes, according to a study1 of the RECORDAF (Registry on Cardiac Rhythm Disorders Assessing the Control of Atrial Fibrillation).

Researchers led by Dr A. John Camm, St George’s University of London, noted the treatment strategies (rhythm control or rate control) of 5,604 patients with recent-onset AF.  At 12 months’ follow up, the therapeutic success of each strategy was observed – this required that strategy was unchanged without clinical events, and that patients were in sinus rhythm in the rhythm-control group, or had a heart rate ≤ 80 beats/min in the rate-control group

Assessing data from 5,171 patients, the authors found 54% overall therapeutic success (rhythm control 60% vs. rate control 47%), although roughly half of patients had changed their pharmacological AF treatment since baseline.  After adjustment for propensity score quintiles, the rhythm-control strategy was significantly related to superior therapeutic success (p < 0.0002).

The type (persistent), presence at baseline visit, and duration (>3 months) of AF, together with age older than 75 years and the presence of heart failure, predicted progression to permanent AF. The choice of rhythm control reduced the likelihood of AF progression (p < 0.0001).

The authors claim that, despite limitations inherent in real-life observational studies, this study shows that within 12 months clinical outcomes are not influenced by the choice of rhythm control versus rate control, but are mainly driven by hospitalisations due to arrhythmia/proarrhythmia and other cardiovascular causes.

Nevertheless, they add, “AF is better controlled in clinical terms with a rhythm-control strategy, and the likelihood of progression to permanent AF is less with

rhythm-control than with rate-control therapy”.  They point out that major cardiovascular outcomes are more dependent on comorbidity than the choice of cardiac rhythm management, a finding which “confirms and complements results reported in previous rate-control versus rhythm control randomised, controlled trials”.

References

1 Camm AJ, Breithardt G, Crijns H, et al.  Real-Life Observations of Clinical Outcomes With Rhythm- and Rate-Control Therapies for Atrial Fibrillation: RECORDAF (Registry on Cardiac Rhythm Disorders Assessing the Control of Atrial Fibrillation).  JACC 2011;58:493–501.

Published on: August 2, 2011

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ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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