Ventricular rate control as an endpoint for treatment of atrial fibrillation

Interest in the use of rate control as an endpoint for managing atrial fibrillation likely will increase given the results of recent randomized clinical trials. As an endpoint, rate control has favorable attributes of ease of measurement and clear numerical definitions. Pharmacologic rate control is achieved in approximately 80% of patients in large clinical trials. Ablation and pacing may achieve rate control in all patients. Rate control has been shown to improve quality of life over pretreatment status. However, several issues regarding the use of rate control as an endpoint are unsettled. Technical issues concerning when and how to measure heart rate remain. The current definitions of rate control are lacking in scientific foundation and demonstration of clinical relevance. Heart rate control during exercise may be difficult to achieve in many patients despite control at rest. Finally, the relationship of rate control to some important clinical outcomes has not been established.