Rhythm Control versus Rate Control for Atrial Fibrillation and Heart Failure

• Published in: The New England journal of medicine Vol. 358; no. 25; pp. 2667 - 2677
• Main Authors: Roy, Denis, Talajic, Mario, Nattel, Stanley, Wyse, D. George, Dorian, Paul, Lee, Kerry L, Bourassa, Martial G, Arnold, J. Malcolm O, Buxton, Alfred E, Camm, A. John, Connolly, Stuart J, Dubuc, Marc, Ducharme, Anique, Guerra, Peter G, Hohnloser, Stefan H, Lambert, Jean, Le Heuzey, Jean-Yves, O'Hara, Gilles, Pedersen, Ole Dyg, Rouleau, Jean-Lucien, Singh, Bramah N, Stevenson, William G, Stevenson, Lynne Warner, Thibault, Bernard, Waldo, Albert L
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 19.06.2008
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Aged; Amiodarone - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Anti-Arrhythmia Agents - therapeutic use; Atrial Fibrillation - prevention & control; Biological and medical sciences; Cardiac arrhythmia; Cardiac dysrhythmias; Cardiology; Cardiology. Vascular system; Cardiovascular Diseases - mortality; Clinical outcomes; Clinical trials; Combined Modality Therapy; Digitalis Glycosides - therapeutic use; Electric Countershock; Female; Follow-Up Studies; General aspects; Heart; Heart failure; Heart Failure - complications; Heart Failure - drug therapy; Heart Failure - therapy; Heart Rate; Hospitalization - statistics & numerical data; Humans; Kaplan-Meier Estimate; Male; Medical research; Medical sciences; Medical treatment; Middle Aged; Prospective Studies; Ventricular Dysfunction, Left; Heart failure; Medicine; Heart rate; Arrhythmia; Cardiac frequency; Heart disease; Atrial fibrillation; Cardiovascular disease; Excitability disorder; Comparative study
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa0708789

In this clinical trial involving patients with atrial fibrillation and congestive heart failure, rhythm control (to maintain sinus rhythm) and rate control (to control the ventricular rate in atrial fibrillation) were compared. The two strategies were nearly identical with respect to all clinical outcomes. Thus, the simpler approach, rate control, should be considered the treatment of choice in such patients. In patients with atrial fibrillation and congestive heart failure, rhythm control and rate control were nearly identical with respect to all clinical outcomes. Thus, the simpler approach, rate control, should be considered the treatment of choice in such patients. Atrial fibrillation and congestive heart failure are common cardiac disorders associated with substantial morbidity and mortality. 1 – 7 Atrial fibrillation can lead to heart failure, and heart failure can lead to atrial fibrillation, which is present in 10 to 50% of patients with heart failure. 8 – 14 An excessive ventricular rate, a loss of atrial contraction, and an irregular ventricular filling time that is associated with atrial fibrillation may all have negative clinical consequences in patients with heart failure. Most of the available evidence suggests that such patients with atrial fibrillation have a worse prognosis than those in whom sinus rhythm is . . .