Related Experiment Video
Updated: Jan 21, 2026
Fusion of Secretory Vesicles with the Plasma Membrane
A comparison of rate control and rhythm control in patients with atrial fibrillation
D G Wyse1, A L Waldo, J P DiMarco
1AFFIRM Clinical Trial Center, Axio Research, 2601 4th Ave., Ste. 200, Seattle, WA 98121, USA.
Insights
Rhythm-control therapy for atrial fibrillation (AF) does not improve survival compared to rate-control therapy. Rate-control may offer advantages like fewer adverse drug effects for high-risk AF patients.
Area of Science:
- Cardiology
- Clinical Medicine
- Pharmacology
Background:
- Atrial fibrillation (AF) management involves two main strategies: rhythm-control (cardioversion and antiarrhythmic drugs) and rate-control (medications to manage heart rate).
- Anticoagulant therapy is recommended for both approaches in AF patients.
- High-risk patients with AF face significant risks of stroke and mortality.
Purpose of the Study:
- To compare the effectiveness and safety of rhythm-control versus rate-control strategies in patients with atrial fibrillation.
- To determine the impact of these strategies on overall mortality in high-risk individuals.
Main Methods:
- A randomized, multicenter trial involving 4060 patients with atrial fibrillation and high risk of stroke or death.
- Primary endpoint was overall mortality.
- Patients were assigned to either rhythm-control or rate-control therapy, with anticoagulant use recommended for both.
Main Results:
- No significant difference in overall mortality between rhythm-control (23.8% at five years) and rate-control (21.3%) groups (hazard ratio, 1.15; P=0.08).
- The rhythm-control group experienced more hospitalizations and adverse drug effects.
- Most strokes occurred when anticoagulation was interrupted or subtherapeutic.
Conclusions:
- The rhythm-control strategy for atrial fibrillation does not offer a survival benefit over the rate-control strategy.
- Rate-control therapy may be advantageous due to a lower risk of adverse drug effects.
- Continued anticoagulation is crucial for high-risk atrial fibrillation patients, regardless of the chosen rate or rhythm control strategy.
Background:
There are two approaches to the treatment of atrial fibrillation: one is cardioversion and treatment with antiarrhythmic drugs to maintain sinus rhythm, and the other is the use of rate-controlling drugs, allowing atrial fibrillation to persist. In both approaches, the use of anticoagulant drugs is recommended.
Methods:
We conducted a randomized, multicenter comparison of these two treatment strategies in patients with atrial fibrillation and a high risk of stroke or death. The primary end point was overall mortality.
Results:
A total of 4060 patients (mean [+/-SD] age, 69.7+/-9.0 years) were enrolled in the study; 70.8 percent had a history of hypertension, and 38.2 percent had coronary artery disease. Of the 3311 patients with echocardiograms, the left atrium was enlarged in 64.7 percent and left ventricular function was depressed in 26.0 percent. There were 356 deaths among the patients assigned to rhythm-control therapy and 310 deaths among those assigned to rate-control therapy (mortality at five years, 23.8 percent and 21.3 percent, respectively; hazard ratio, 1.15 [95 percent confidence interval, 0.99 to 1.34]; P=0.08). More patients in the rhythm-control group than in the rate-control group were hospitalized, and there were more adverse drug effects in the rhythm-control group as well. In both groups, the majority of strokes occurred after warfarin had been stopped or when the international normalized ratio was subtherapeutic.
Conclusions:
Management of atrial fibrillation with the rhythm-control strategy offers no survival advantage over the rate-control strategy, and there are potential advantages, such as a lower risk of adverse drug effects, with the rate-control strategy. Anticoagulation should be continued in this group of high-risk patients.
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