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It is thought that the loss of atrial kick in patients with congestive heart failure contributes to the symptoms — and ultimately the morbidity and mortality — of the condition. Therefore, by inference, maintenance of sinus rhythm should improve heart failure symptoms and mortality. Two research groups have recently examined this hypothesis.
In an international randomized trial, 682 heart failure patients with a history of atrial fibrillation received treatment aimed at achieving sinus rhythm control, and 694 received treatment aimed at achieving a target ventricular heart rate. All participants had LV ejection fractions ≤35%, and two thirds had persistent, rather than paroxysmal, AF. In the rhythm-control group, 82% of patients received ami…