Rhythm control significantly reduced the primary composite endpoint compared to rate control in patients with paroxysmal atrial fibrillation (15.3% vs 22.0%, P=0.0128).
RCT (n=823)
Yes
Does a rhythm control strategy reduce the composite of mortality, cardiovascular morbidity, and treatment crossover due to disability compared to a rate control strategy in patients with paroxysmal atrial fibrillation?
In patients with paroxysmal atrial fibrillation, a rhythm control strategy reduced the primary composite endpoint compared to rate control, driven entirely by a reduction in physical/psychological disability requiring treatment crossover, with no difference in hard cardiovascular outcomes.
Absolute Event Rate: 15.3% vs 22%
p-value: p=0.0128
Background Although previous clinical trials demonstrated the non-inferiority of a rate control to rhythm control strategy for management of atrial fibrillation (AF), the optimal treatment strategy for paroxysmal AF (PAF) remains unclear. Methods and Results A randomized, multicenter comparison of rate control vs rhythm control in Japanese patients with PAF (the Japanese Rhythm Management Trial for Atrial Fibrillation (J-RHYTHM) study) was conducted. The primary endpoint was a composite of total mortality, symptomatic cerebral infarction, systemic embolism, major bleeding, hospitalization for heart failure, or physical/psychological disability requiring alteration of treatment strategy. In the study, 823 patients with PAF were followed for a mean period of 578 days. The primary endpoint occurred in 64 patients (15.3%) assigned to rhythm control and in 89 patients (22.0%) to rate control (P=0.0128). No significant differences between the treatment strategies were observed in the incidences of death, stroke, bleeding and heart failure. Meanwhile, significantly fewer patients requested changes of assigned treatment strategy in the rhythm control vs the rate control group, which was accompanied by improvement in AF-specific quality of life scores. Conclusion The J-RHYTHM study showed that rhythm control was associated with fewer primary endpoints than rate control. However, mortality and cardiovascular morbidity were not affected by the treatment strategy (umin-CTR No. C000000106).
Ogawa et al. (Thu,) conducted a rct in Paroxysmal atrial fibrillation (n=823). Rhythm control vs. Rate control was evaluated on Composite of total mortality, symptomatic cerebral infarction, systemic embolism, major bleeding, hospitalization for heart failure, or physical/psychological disability requiring alteration of treatment strategy (p=0.0128). Rhythm control significantly reduced the primary composite endpoint compared to rate control in patients with paroxysmal atrial fibrillation (15.3% vs 22.0%, P=0.0128).