What does this research mean for the field?

Rhythm control significantly reduces the primary composite endpoint compared to rate control in patients with paroxysmal atrial fibrillation, primarily due to fewer treatment strategy changes and improved quality of life, without affecting mortality or cardiovascular morbidity. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 1, 2009Circulation JournalOpen Access

Optimal Treatment Strategy for Patients With Paroxysmal Atrial Fibrillation J-RHYTHM Study

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Paroxysmal atrial fibrillation (n=823). Intervention: Rhythm control vs. Rate control. Primary outcome: 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).

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Key result

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).

Why the study?

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?

Population

823 Japanese patients with paroxysmal atrial fibrillation expected to convert spontaneously to sinus rhythm…

Comparison

Rhythm control strategy using antiarrhythmic… vs Rate control strategy using beta-blockers…

Design

RCT, Randomly assigned to either the rate control or rhythm control treatment…

Follow-up

mean 578 days

Authors

SOSatoshi OgawaNational Institute of Technology, Niihama College TYTakeshi YamashitaKanazawa University TYTsutomu YamazakiKanazawa University

Discussion

Member takes

Implication

Supports preferring rhythm control over rate control in paroxysmal AF; extends prior data by showing reduced crossover without hard outcome differences.

Study Design

Type

RCT (n=823)

Multicenter

Yes

Structured PICO

Population

823 Japanese patients with paroxysmal atrial fibrillation (PAF) expected to convert spontaneously to sinus rhythm within 48 hours, mean age 64.7, 69.3% male. Key exclusions: initial AF episodes, contraindication for anticoagulation, and AF occurring during the acute phase of myocardial infarction or cardiac surgery.

Intervention

Rhythm control strategy using antiarrhythmic drugs (predominantly class I drugs such as pilsicainide, cibenzoline, propafenone) selected according to Japanese guidelines, plus oral antithrombotic therapy (warfarin) based on stroke risk factors.

Comparator

Rate control strategy using beta-blockers, calcium-channel blockers, and digitalis, plus oral antithrombotic therapy (warfarin) based on stroke risk factors.

Outcome

Composite of total mortality, symptomatic cerebral infarction, systemic embolism, major bleeding, hospitalization for heart failure requiring intravenous administration of diuretics, and physical/psychological disability requiring alteration of the assigned treatment strategy.composite

Main Result

Absolute Event Rate: 15.3% vs 22%

p-value: p=0.0128

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.

Limitations

Therapeutic strategies were not blinded to physicians and patients, which could lead to biases in the occurrence of endpoints
Transtelephonic monitoring could not be used to evaluate drug effects on PAF
Most patients in the present study had no structural heart disease

Cite This Study

Ogawa et al. (2009) conducted an 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).

synapsesocial.com/papers/6a15933979ff98d0de4ed5cb https://doi.org/10.1253/circj.cj-08-0608

Topics

Persistent AF management Atrial fibrillation Anticoagulation in AF AF ablation outcomes

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Implication

Supports preferring rhythm control over rate control in paroxysmal AF; extends prior data by showing reduced crossover without hard outcome differences.

Optimal Treatment Strategy for Patients With Paroxysmal Atrial Fibrillation J-RHYTHM Study

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Optimal Treatment Strategy for Patients With Paroxysmal Atrial Fibrillation J-RHYTHM Study

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider