March 15, 2010New England Journal of Medicine
Lenient versus Strict Rate Control in Patients with Atrial Fibrillation
Population
Patients with permanent atrial fibrillation
Comparison
Lenient rate control vs Strict rate control
Design
RCT
Authors
Discussion
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Our study suggests that lenient rate control may be adopted as the first-choice rate control strategy in patients with permanent atrial fibrillation, and this applies both for high- and low-risk patients. … If a patient comes into the office with permanent atrial fibrillation, a target resting heart rate just under 110 bpm on a 12-lead ECG is good enough.”
Implication
Supports lenient rate control in permanent AF; confirms RCT noninferiority with easier achievement versus strict targets.
Key Points
- To assess whether a lenient rate-control strategy is noninferior to strict rate control in patients with permanent atrial fibrillation.
- Conducted a randomized clinical trial (ClinicalTrials.gov number NCT00392613) in patients diagnosed with permanent atrial fibrillation.
- Assigned patients to either a lenient rate-control target or a strict rate-control target.
- Lenient rate control achieved clinical efficacy comparable to strict rate control in patients with permanent atrial fibrillation.
- The lenient rate-control target proved easier to achieve in clinical practice than the strict rate-control target.
Structured PICO
P
Population
Patients with permanent atrial fibrillation
I
Intervention
Lenient rate control
C
Comparator
Strict rate control
Lenient rate control is as effective as strict rate control and easier to achieve in patients with permanent atrial fibrillation.
Cite This Study
Gelder et al. (2010) studied this question.