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In randomized trials in patients with atrial fibrillation (AF), treatment strategies that restore and maintain sinus rhythm (rhythm control) have not shown convincing advantages over those that simply control heart rate (rate control). But which strategy is better for patients with AF and heart failure, among whom AF predicts worse outcomes?
Investigators enrolled 1376 adults with heart failure symptoms, left ventricular ejection fractions ≤35%, and histories of AF. Patients were assigned to rhythm-control or rate-control strategies. Patients with persistent AF (>12 months) were excluded. During follow-up (mean, 37 months), the primary outcome of cardiovascular death did not differ significantly between the rhythm-control (27%) and the rate-…