atrial fibrillation, rate control strategy
DISEASE INTERVENTION COMPARISON RESULTS
Arch Cardiovasc Dis. 2012 Apr;105(4):226-38 Meta-Analysis
IN atrial fibrillation, rate control strategy The Use of
rate control strategy
As Treatment, Chronic
Is equal Than
rhythm control strategy
To modify mortality, stroke, embolism or major bleeding
Pacing Clin Electrophysiol. 2013 Jan;36(1):122-33 Meta-Analysis
IN atrial fibrillation, rate control strategy The Use of
rate control strategy
As Treatment, Chronic
Is equal Than
rhythm control strategy
To rate control carried fewer hospitalizations with no differences in mortality or other outcomes. In 5 studies with few patients (50 to 250, 650 patients total) conducted in patients <65 years old, rate control was associated with higher mortality
Br J Clin Pharmacol. 2005 Oct;60(4):347-54 Meta-Analysis
IN atrial fibrillation, rate control strategy The Use of
rate control strategy
As Treatment, Chronic
Is better Than
rhythm control strategy (cardioversion and antiarrhythmics)
To reduce adverse effects and hospitalizations. Complications of AF: death, ischaemic stroke and non-CNS bleeding were similar.
Cochrane Database Syst Rev. 2005 Apr 18;(2):CD003713 Systematic Review, Cochrane Review
IN atrial fibrillation, rate control strategy The Use of
rate control strategy
As Treatment, Chronic
Is better Than
rhythm control strategy using pharmacologic cardioversion and antiarrhythmics
To reduce complications of AF: mortality was similar, rhythm control associated more adverse effects and hospitalisations
J Am Coll Cardiol. 2005 Nov 15;46(10):1891-9. Epub 2005 Oct 21 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, rate control strategy, functional status The Use of
rhythm control strategy (various antiarrhythmics)
As Treatment, Chronic
Is equal Than
rate control strategy
To modify functional status of patients: modest improvement in 6-min walk distance was noted in the rhythm-control arm (about 30m) no difference appeared in dyspnea, angor or cognitive function
Am J Med. 2006 May;119(5):448.e1-19 Systematic Review
IN atrial fibrillation, rate control strategy, functional status The Use of
rhythm control strategy (various antiarrhythmics)
As Treatment, Chronic
Is better Than
rate control strategy
To to improve quatily of life: 3 of 4 RCTs found a better improvement in QoL with rate control. Not compared patients in whom SR was restored with those in persistent AF.
Am J Med. 2013 Oct;126(10):887-93 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, rate control strategy, older patients The Use of
rate control strategy
As Treatment, Chronic
Is better Than
rhythm control strategy
To improve overall mortality at 3.4 years : 18% in rate control VS 23% in rhythm control
Ann Intern Med. 2014 Jun 03;160(11):760-73 Systematic Review
IN atrial fibrillation, rate control strategy, older patients with mild AF symptoms The Use of
rate control strategy
As Treatment, Chronic
Is equal Than
rhythm control strategy
To modify all cause mortality, cardiac mortality or stroke
Am Heart J. 2002 Oct;144(4):597-607 Randomized Controlled Trial
IN Study ID: AF-CHF 2008 (subordinated publication), atrial fibrillation, rate control strategy, heart failure, chronic, systolic The Use of
rhythm control: electrical cardioversion combined with antiarrhythmic drugs (amiodarone or other class III agents)
As Treatment, Chronic
Is undefined Than
rate control
To primary end point : cardiovascular mortality (protocol for a RCT)
N Engl J Med. 2008 Jun 19;358(25):2667-77 Randomized Controlled Trial, Multicenter Study
IN Study ID: AF-CHF 2008, atrial fibrillation, rate control strategy, heart failure, chronic, systolic The Use of
rate control strategy
As Treatment, Chronic
Is equal Than
rhythm control strategy
To modify death from cardiovascular causes (25% rate-control VS 27% rhythm-control) or reduce stroke (4% rate-control VS 3% rhythm-control) or worsening heart failure (31% rate-control VS 28% rhythm-control)
N Engl J Med. 2002 Dec 5;347(23):1825-33 Randomized Controlled Trial
IN StudyID: AFFIRM 2002, atrial fibrillation, rate control strategy The Use of
rate control strategy (drugs and anticoagulation)
As Treatment, Chronic
Is equal Than
rhythm control strategy (cardioversion and antiarrhythmics, anticoagulation recommended)
To overall mortality: 4,26%/year in rate-c vs 4,76%/year in rhythm-c. More patients in rhythm-c were hospitalized and suffered adverse drug effects
Arch Intern Med. 2005 Feb 14;165(3):258-62 Meta-Analysis
IN StudyID: Denus 2005, atrial fibrillation, rate control strategy The Use of
rate control strategy (drugs and anticoagulation)
As Treatment, Chronic
Is equal Than
rhythm control strategy (cardioversion and antiarrhythmics)
To reduce all-cause mortality: 14.6% rhythm-control vs 13.0% rate-control. A trend existed in favour of rate-control: OR 0.87; 95%CI 0.74-1.02
Eur Heart J. 2003 Aug;24(15):1430-6 Randomized Controlled Trial
IN StudyID: PIAF 2000 (subordinated publication), atrial fibrillation, rate control strategy, functional status The Use of
rhythm control strategy (amiodarone)
As Treatment, Chronic
Is equal Than
rate control strategy (verapamil and anticoagulation)
To impact on quality of life - at 1 year
Lancet. 2000 Nov 25;356(9244):1789-94 Randomized Controlled Trial
IN StudyID: PIAF 2000, atrial fibrillation, rate control strategy The Use of
rhythm control strategy (amiodarone)
As Treatment, Acute
Is equal Than
rate control strategy (verapamil and anticoagulation)
To improvement in symptoms related to atrial fibrillation. Exercise tolerance is better with rhythm control, although hospital admission is more frequent. Only 23% patients in amiodarone were in sinus rhythm at 1 year.
N Engl J Med. 2002 Dec 5;347(23):1834-40 Randomized Controlled Trial
IN StudyID: RACE 2002, atrial fibrillation, rate control strategy The Use of
rate control strategy (drugs and anticoagulation)
As Treatment, Chronic
Is equal Than
rhythm control strategy (electrical cardioversion and antiarrhythmics, anticoagulation recommended)
To combined events (cardiovascular death, heart failure, any embolism, bleeding, severe drug adverse effects, pacemaker): 3,44%/year in rate-c vs 4,52%/year in rhythm-c. Patients in sinus rhythm at 2,3 years were 10% in rate-c vs 39% in rhythm-c
J Am Coll Cardiol. 2003 May 21;41(10):1690-6 Randomized Controlled Trial
IN StudyID: STAF 2003, atrial fibrillation, rate control strategy The Use of
rate control strategy (pharmacologic or invasive rate-control and anticoagulation)
As Treatment, Chronic
Is equal Than
rhythm control strategy (restoration and maintenance of sinus rhythm)
To combined major cardiovascular events (death, heart arrest, stroke, and systemic embolism): 6.09%/year in rate-c vs 5.54%/year in rhythm-c. Patients in sinus rhythm at 3 years were 0% in rate-c vs 23% in rhythm-c
Eur Heart J. 2005 Oct;26(19):2000-6. Epub 2005 May 4 Meta-Analysis
IN StudyID: Testa 2005, atrial fibrillation, rate control strategy The Use of
rate control strategy
As Treatment, Chronic
Is better Than
rhythm control strategy
To reduce a combined endpoint of all cause death and thromboembolic stroke (OR 0.84 (0.73, 0.98)). No difference in all-cause death, systemic embolism and major bleeding.