Pharmacologic rate versus rhythm-control strategies in atrial fibrillation: an updated comprehensive review and...

Area of Science:

• Cardiology
• Pharmacology
• Clinical Trials

Background:

• Ventricular rate control is a guideline-accepted therapeutic option for atrial fibrillation (AF).
• Previous studies often excluded patients with permanent AF or left ventricular dysfunction.
• Rate control has been shown to be noninferior to rhythm control in preventing clinical events.

Purpose of the Study:

• To systematically review randomized controlled trials comparing pharmacological rate-control and rhythm-control strategies in patients with atrial fibrillation (AF).
• To assess the primary outcome of all-cause mortality and other clinical endpoints.
• To evaluate the impact of these strategies on rehospitalization rates.

Main Methods:

• Systematic search of PubMed, CENTRAL, and EMBASE databases for randomized controlled trials (RCTs) published between 1966 and 2011.
• Inclusion of direct head-to-head comparisons of pharmacological rate- and rhythm-control strategies.
• Meta-analysis using a random-effects model to pool data on all-cause mortality and other clinical endpoints.

Main Results:

• Ten studies (N = 7,867) met the inclusion criteria.
• No significant difference was found in in-hospital mortality, stroke, systemic embolism, heart failure, myocardial infarction, or bleeding between the two strategies.
• Rate control was associated with significantly lower rehospitalization rates (P = 0.007).
• An exploratory analysis indicated rhythm control was superior in preventing all-cause mortality in patients younger than 65 years (P = 0.0007).

Conclusions:

• Neither rate nor rhythm control strategy demonstrated a significant difference in overall clinical outcomes for patients with AF.
• Pharmacological rate control appears to reduce rehospitalization rates across all age groups.
• Rhythm control may offer a survival benefit in younger patients (<65 years) with AF.