Rate vs Rhythm Control in Patients With Atrial Fibrillation: A Meta-analysis

de Denus, Simon

doi:10.1001/archinte.165.3.258

Cited by 239Atrial Fibrillation Management and OutcomesCardiac pacing and defibrillation studiesCardiac Arrhythmias and Treatments

Rate vs Rhythm Control in Patients With Atrial Fibrillation: A Meta-analysis

de Denus, Simon·2005·Archives of Internal Medicine

DOI 10.1001/archinte.165.3.258

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Abstract

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

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All trials that have compared rhythm control to rate control (with appropriate anticoagulation) therapy have resulted in neutral outcomes.
“Although many clinicians believe that maintaining sinus rhythm can improve outcomes in AF patients, 588 all trials that have compared rhythm control to rate control (with appropriate anticoagulation) therapy have resulted in neutral outcomes.41,578,579,582,[589][590][591][592][593]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [579]

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Authors: de Denus, S.
Venue: Archives of Internal Medicine
Publisher: American Medical Association (AMA)
Published: 2005-02-14
Volume: 165
Issue: 3
Pages: 258
ISSN: 0003-9926 (ISSN-L)
DOI: 10.1001/archinte.165.3.258
OpenAlex: W1989801282
Cited by: 239
References: 20
Citations by year: 2026: 2 · 2025: 2 · 2024: 8 · 2023: 3 · 2022: 12 · 2021: 12 · 2020: 4 · 2019: 4 · 2018: 8 · 2017: 7 · 2016: 6 · 2015: 7 · 2014: 12 · 2013: 21 · 2012: 25
FWCI: 13.45
Type: journal article
Language: en
Open access: closed
Locations: Archives of Internal Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
Keywords: atrial fibrillation, rate control, rhythm control, antiarrhythmic drugs, all-cause mortality, persistent atrial fibrillation, anticoagulation, first-line therapy
MeSH terms: Aged, Anti-Arrhythmia Agents, Anticoagulants, Atrial Fibrillation, Cardiovascular Agents, Combined Modality Therapy, Drug Therapy, Combination, Electric Countershock, Female, Heart Rate, Humans, Male, Recurrence, Odds Ratio, Randomized Controlled Trials as Topic, Stroke

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Rate vs Rhythm Control in Patients With Atrial Fibrillation: A Meta-analysis

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