Run baby run … but not too fast! Rate control management in atrial fibrillation: a claim for personalization
Why the study?
Does a higher ventricular rate (≥100 bpm) increase mortality and heart failure risk in patients with atrial fibrillation?
Population
Over 7000 patients presenting with a first-time ECG with atrial fibrillation or atrial flutter, who were…
Comparison
Heart rate ≥100 b.p.m. (lenient rate control) vs Lower heart rate (strict rate control)
Design
Editorial
Follow-up
1 year
Authors
Discussion
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Member takes
Implication
This editorial emphasizes that higher ventricular rates (≥100 bpm) in atrial fibrillation are associated with increased mortality and heart failure, challenging the universal application of lenient rate control and advocating for personalized management.
Structured PICO
Does a higher ventricular rate (≥100 bpm) increase mortality and heart failure risk in patients with atrial fibrillation?
P
Population
Over 7000 patients presenting with a first-time ECG with atrial fibrillation or atrial flutter, who were dispensed with rate-control drugs at the time of ECG recording (from years 2001 to 2015).
I
Intervention
Heart rate ≥100 b.p.m. (lenient rate control)
C
Comparator
Lower heart rate (strict rate control)
O
Outcome
1-year mortality and risk of developing new heart failurehard clinical
This editorial emphasizes that higher ventricular rates (≥100 bpm) in atrial fibrillation are associated with increased mortality and heart failure, challenging the universal application of lenient rate control and advocating for personalized management.
Limitations
- Observational study design of the referenced cohort
- Lack of agent-specific sub-analysis to determine if specific drug choices affected results
- Limitations of wearables (e.g., photoplethysmographic signal reliability at high heart rates) for everyday rate control assessment
Cite This Study
Diemberger et al. (2023) studied this question.