Rhythm Control vs. Rate Control for Patients with Afib

These older patients fared no better with rhythm control than with rate control, and rhythm control was associated with more treatment-related adverse events.

For patients with atrial fibrillation (AF), clinicians either can try to restore sinus rhythm (rhythm control) or can allow persistent AF while controlling ventricular rate (rate control). Although cardiologists often favor rhythm control initially, the lack of supporting evidence for this approach led to these 2 randomized trials.

North American researchers enrolled 4060 patients with recent AF (but generally not more than 6 months of continuous AF) who were at least 65 or had risk factors for stroke. Patients were randomized to rhythm control (antiarrhythmic drugs and cardioversion as necessary) or to rate control (β-blockers, calcium-blockers, digoxin, or a combination of these) and were followed for an average of 3.5 years. Both groups r…

Reviewing Author

Allan S. Brett, MD