Key result
In a review of 5 trials (N=5175), rhythm control using antiarrhythmic drugs was more expensive but not more effective than rate control in preventing major adverse events in atrial fibrillation.
Why the study?
Does rhythm control using antiarrhythmic drugs reduce major adverse events compared to rate control in patients with atrial fibrillation?
Does rhythm control using antiarrhythmic drugs reduce major adverse events compared to rate control in patients with atrial fibrillation?
For most patients with atrial fibrillation, rhythm control with antiarrhythmic drugs is not more effective than rate control for preventing major adverse events, though it is associated with increased resource use.
Supports rate control preference in AF to limit costs; leaves open whether modern strategies improve outcomes.
Purpose of review The results of five randomized clinical trials comparing rate control with rhythm control in the management of atrial fibrillation have been published recently. The purpose of this report is to review their main results and selected subanalyses and other related data to offer practical recommendations regarding the treatment of patients with this common arrhythmia. Recent findings In the aggregate, the five trials enrolled a total of 5175 subjects and accumulated 16,186 patient-years of follow-up. All these trials have had similar results in that each of them failed to demonstrate a clear advantage of the rhythm control approach over that of rate control. The largest of the studies, the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study, enrolled 79% of all the cases in the five trials and accounts for 88% of the cumulative follow-up experience and for 92% of all deaths. Among AFFIRM participants, antiarrhythmic drug use did not improve survival, stroke risk, quality of life, or functional capacity but was associated with increased resource use. In several of the trials, however, the presence of sinus rhythm was associated with improved outcomes. Summary The evidence is now overwhelming that for most patients with atrial fibrillation, rhythm control using currently available antiarrhythmic drugs is more expensive but not more effective than the rate control strategy in the prevention of major adverse events. Further research is needed to determine whether maintaining sinus rhythm by other means can improve outcomes.
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Vidaillet et al. (2005) conducted a review in atrial fibrillation (n=5,175). rhythm control vs. rate control was evaluated on major adverse events. In a review of 5 trials (N=5175), rhythm control using antiarrhythmic drugs was more expensive but not more effective than rate control in preventing major adverse events in atrial fibrillation.
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