Key result
Rate control is a legitimate primary therapeutic option for atrial fibrillation, as four clinical trials failed to demonstrate survival or stroke advantages with rhythm control.
Why the study?
Does rate control compared to rhythm control provide similar or better outcomes in patients with atrial fibrillation?
Does rate control compared to rhythm control provide similar or better outcomes in patients with atrial fibrillation?
Rate control should be considered a legitimate primary therapeutic option for atrial fibrillation, particularly in patients at risk for stroke.
Supports rate control as primary AF option; challenges historical rhythm control consensus.
Until recently, the standard approach to therapy of atrial fibrillation (AF) in most cases was restoration and maintenance of sinus rhythm (rhythm control). Although difficult to accomplish, and associated with potential serious adverse effects of antiarrhythmic agents, this therapeutic approach was influenced by the belief that rhythm control was associated with better survival, fewer symptoms, better exercise tolerance, lower risk of stroke, better quality of life, and absence of need for long-term anticoagulation. However, four clinical trials comparing rate control with rhythm control have failed to demonstrate these advantages, indicating that rate control should be considered a legitimate primary therapeutic option, particularly in patients at risk for stroke. Pursuit of rate or rhythm control should be decided on a case-by-case basis.
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Albert L. Waldo (2004) conducted a review in Atrial fibrillation. Rate control vs. Rhythm control was evaluated. Rate control is a legitimate primary therapeutic option for atrial fibrillation, as four clinical trials failed to demonstrate survival or stroke advantages with rhythm control.
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