Why the study?
Does a rhythm-control strategy improve survival compared to a rate-control strategy in high-risk patients with atrial fibrillation?
Does a rhythm-control strategy improve survival compared to a rate-control strategy in high-risk patients with atrial fibrillation?
A rhythm-control strategy offers no survival advantage over a rate-control strategy in high-risk patients with atrial fibrillation, while rate control may have a lower risk of adverse drug effects.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“data from several trials have demonstrated that the success of antiarrhythmic medications (AADs) in maintaining sinus rhythm is borderline, at best, with increasing failure rates over time… AADs clearly do not cure A-Fib; at best, they are a palliative treatment used to reduce the burden of A-Fib as opposed to eliminating it altogether. …in our experience rhythm control is not only ineffective and poorly tolerated, but only delays an inevitable ablation.”
“If you want to get people back into rhythm, you need to move quickly before you get irreversible changes to the heart that make it very difficult.”
“This study shows that rhythm control has benefits beyond symptom relief. In patients who were recently diagnosed with atrial fibrillation, an early rhythm control strategy can improve not just symptoms but also hard outcomes like stroke and mortality.”
Supports rate control to limit adverse effects in high-risk AF; leaves open whether contemporary rhythm strategies improve outcomes.
Management of atrial fibrillation with the rhythm-control strategy offers no survival advantage over the rate-control strategy, and there are potential advantages, such as a lower risk of adverse drug effects, with the rate-control strategy. Anticoagulation should be continued in this group of high-risk patients.
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Wyse et al. (2002) studied this question.
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