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Rate versus rhythm control in atrial fibrillation
Korin K Anthony1, Vincent F Mauro
1University of Toledo, Toledo, OH, USA. korinrph@hotmail.com
The Annals of Pharmacotherapy
|March 25, 2004
Summary
Rate control is a viable initial treatment for persistent atrial fibrillation (AF), showing no inferiority to rhythm control regarding mortality. This approach also reduces hospitalizations and adverse effects, making it a reasonable first-line strategy, particularly for elderly patients.
Area of Science:
- Cardiology
- Clinical Trials
- Pharmacology
Background:
- Persistent atrial fibrillation (AF) management strategies include rate and rhythm control.
- Recent trials have compared the efficacy and safety of these two approaches.
Purpose of the Study:
- To evaluate if rate control is a viable initial treatment for persistent AF.
- To compare rate control versus rhythm control in managing AF based on recent trial data.
Main Methods:
- Biomedical literature search of MEDLINE and the Iowa database (1966-2003).
- Inclusion of relevant articles identified from the literature search.
- Review and synthesis of data from selected studies.
Main Results:
- Rate control demonstrated non-inferiority to rhythm control concerning mortality in persistent AF.
- Rate control was associated with reduced hospitalizations and fewer proarrhythmic events.
- No significant differences were found between rate and rhythm control for thromboembolism and stroke incidence.
Conclusions:
- Rate control is a reasonable first-line strategy for persistent AF, especially in asymptomatic or mildly symptomatic elderly patients.
- Rhythm control is linked to higher hospitalization rates and antiarrhythmic drug adverse effects.
- Further research is necessary to define the role of rate control in younger AF patients.