The effects of rhythm control strategies versus rate control strategies for atrial fibrillation and atrial flutter: A systematic review with meta-analysis and Trial Sequential Analysis

Figures

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  Fig 1. PRISMA flow diagram. We screened 16 952 records and included 56 publications of 25 trials in this systematic review.

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  Fig 2. Forest plot of the meta-analysis of all-cause mortality. Meta-analysis showed no significant difference between rhythm control strategies and rate control strategies when assessing all-cause mortality.

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  Fig 3. Trial Sequential Analysis of all-cause mortality. Trial Sequential Analysis (TSA) showed that there was not enough information to confirm or reject a risk ratio reduction of 15% (TSA-adjusted confidence interval 0.90 to 1.22). The Z-curve (the blue line) does not cross any boundaries.

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  Fig 4. Forest plot of the meta-analysis of serious adverse events. Meta-analysis showed that rhythm control strategies versus rate control strategies significantly increased the risk of a serious adverse event.

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  Fig 5. Trial Sequential Analysis of serious adverse events. Trial Sequential Analysis (TSA) of serious adverse events showed that there was not enough information to confirm or reject a RRR of 15% (TSA-adjusted confidence interval 0.99 to 1.22). The Z-curve (the blue line) does not cross any boundaries.

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  Fig 6. Forest plot of the meta-analysis of quality of life (the Short Form (36) physical component score (SF-36 PCS)). Meta-analysis showed that rhythm control strategies versus rate control strategies significantly increased the quality of life measured by SF-36 PCS.

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  Fig 7. Trial Sequential Analysis of quality of life (the Short Form (36) physical component score (SF-36 PCS)). Trial Sequential Analysis showed that there was not enough information to confirm or reject a mean difference of 4.81 points (TSA-adjusted confidence interval -3.16 to 17.02). The Z-curve (the blue line) does not cross any boundaries.

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  Fig 8. Forest plot of the meta-analysis of stroke. Meta-analysis showed no significant difference between rhythm control strategies and rate control strategies when assessing stroke.

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  Fig 9. Trial Sequential Analysis of stroke. Trial Sequential Analysis (TSA) showed that there was not enough information to confirm or reject a risk ratio reduction of 15% (TSA-adjusted confidence interval 0.33 to 3.28). The Z-curve (the blue line) does not cross any boundaries.

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  Fig 10. Forest plot of the meta-analysis of ejection fraction. Meta-analysis showed that rhythm control strategies versus rate control strategies significantly increased the ejection fraction.

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  Fig 11. Trial Sequential Analysis of ejection fraction. Trial Sequential Analysis (TSA) showed that there was not enough information to confirm or reject a mean difference of 4.20% (TSA-adjusted confidence interval -2.37 to 10.77). The Z-curve (the blue line) does not cross any boundaries.