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Rate vs rhythm control in patients with atrial fibrillation: a meta-analysis
Journal article   Open access   Peer reviewed

Rate vs rhythm control in patients with atrial fibrillation: a meta-analysis

Simon de Denus, Cynthia A Sanoski, Jörg Carlsson, Grzegorz Opolski and Sarah A Spinler
Archives of internal medicine (1960), Vol.165(3), pp.258-262
02/14/2005
DOI: 10.1001/archinte.165.3.258
PMID: 15710787
url
https://doi.org/10.1001/archinte.165.3.258View
Published (Version of record) Open Access

Abstract

The 2 fundamental approaches to the management of atrial fibrillation (AF) are reestablishing and maintaining sinus rhythm (rhythm control) and controlling ventricular rate with atrioventricular node blocking agents (rate control). We performed a meta-analysis of randomized controlled trials comparing these strategies in patients with AF to add precision to the relative merits of both strategies on the risk of all-cause mortality and to evaluate the consistency of the results between trials. We performed a literature search in MEDLINE (1966 to May 2003), the Cochrane Controlled Trial Registry (first quarter of 2003), and International Pharmaceutical Abstracts (1970 to May 2003). Eligible trials were randomized controlled trials comparing pharmacologic rhythm and rate control strategies as first-line therapy in patients with AF. Five trials were identified that included a total of 5,239 patients with persistent AF or AF that was considered likely to be recurrent. No significant difference was observed between the rate and the rhythm control groups regarding all-cause mortality, although a strong trend in favor of a rate control approach was observed (13.0% vs 14.6%; odds ratio, 0.87; 95% confidence interval, 0.74-1.02; P=.09). No heterogeneity was apparent between the trials (Q value=2.97; P=.56). In patients with persistent AF or with AF that is likely to be recurrent, a strategy of ventricular rate control, in combination with anticoagulation in appropriate patients, appears to be at least equivalent to a strategy of maintaining sinus rhythm by using currently available antiarrhythmic drugs in preventing clinical outcomes.
 Aged Anti-Arrhythmia Agents - therapeutic use Anticoagulants - therapeutic use Atrial Fibrillation - complications Atrial Fibrillation - mortality Atrial Fibrillation - therapy Cardiovascular Agents - therapeutic use Combined Modality Therapy Drug Therapy, Combination Electric Countershock Female Heart Rate Humans Male Odds Ratio Randomized Controlled Trials as Topic Recurrence Stroke - epidemiology Stroke - prevention & control

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