Rhythm control strategies failed to demonstrate a clear advantage over rate control in atrial fibrillation, with a subgroup of 3091 elderly patients showing a higher risk of death with rhythm control.
Does a rhythm-control strategy improve outcomes compared to a rate-control strategy in elderly persons with atrial fibrillation?
In elderly patients with atrial fibrillation, rhythm-control strategies do not offer a clear advantage over rate control and may be associated with a higher risk of mortality.
Antiarrhythmic medications used to maintain sinus rhythm have long been the treatment of choice in atrial fibrillation. The results of five prospective randomized trials comparing the efficacy and safety of rhythm-control to rate-control strategies are now available. Reflecting the epidemiology of atrial fibrillation in the real world, most subjects enrolled in these investigations were elderly persons at increased risk of stroke or death. All of these trials have had similar results; these studies have failed to demonstrate a clear advantage of one treatment strategy over the other. A prespecified subgroup analysis among 3091 elderly patients in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study revealed that rhythm control was associated with a higher risk of death than rate control. This review examines developments leading to and the implications and limitations of these trials and discusses recently issued practice guidelines and the justification for ongoing efforts to develop nonpharmacologic approaches to rhythm management in atrial fibrillation.
Humberto Vidaillet (Tue,) conducted a review in Atrial Fibrillation (n=3,091). Rhythm control vs. Rate control was evaluated on Death. Rhythm control strategies failed to demonstrate a clear advantage over rate control in atrial fibrillation, with a subgroup of 3091 elderly patients showing a higher risk of death with rhythm control.