Cited by 1,585Atrial Fibrillation Management and OutcomesCardiac pacing and defibrillation studiesHeart Failure Treatment and Management

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Rhythm Control versus Rate Control for Atrial Fibrillation and Heart Failure

Roy, Denis, Talajic, Mario, Nattel, Stanley, Wyse, D. George, Dorian, Paul, Lee, Kerry L., Bourassa, Martial G., Arnold, J. Malcolm O., Buxton, Alfred E., Camm, A. John, Connolly, Stuart J., Dubuc, Marc, Ducharme, Anique, Guerra, Peter G., Hohnloser, Stefan H., Lambert, Jean, Le Heuzey, Jean-Yves, O'Hara, Gilles, Pedersen, Ole Dyg, Rouleau, Jean-Lucien, Singh, Bramah N., Stevenson, Lynne Warner, Stevenson, William G., Thibault, Bernard, Waldo, Albert L.·2008·New England Journal of Medicine

DOI 10.1056/nejmoa0708789

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Abstract

BACKGROUND: It is common practice to restore and maintain sinus rhythm in patients with atrial fibrillation and heart failure. This approach is based in part on data indicating that atrial fibrillation is a predictor of death in patients with heart failure and suggesting that the suppression of atrial fibrillation may favorably affect the outcome. However, the benefits and risks of this approach have not been adequately studied. METHODS: We conducted a multicenter, randomized trial comparing the maintenance of sinus rhythm (rhythm control) with control of the ventricular rate (rate control) in patients with a left ventricular ejection fraction of 35% or less, symptoms of congestive heart failure, and a history of atrial fibrillation. The primary outcome was the time to death from cardiovascular causes. RESULTS: A total of 1376 patients were enrolled (682 in the rhythm-control group and 694 in the rate-control group) and were followed for a mean of 37 months. Of these patients, 182 (27%) in the rhythm-control group died from cardiovascular causes, as compared with 175 (25%) in the rate-control group (hazard ratio in the rhythm-control group, 1.06; 95% confidence interval, 0.86 to 1.30; P=0.59 by the log-rank test). Secondary outcomes were similar in the two groups, including death from any cause (32% in the rhythm-control group and 33% in the rate-control group), stroke (3% and 4%, respectively), worsening heart failure (28% and 31%), and the composite of death from cardiovascular causes, stroke, or worsening heart failure (43% and 46%). There were also no significant differences favoring either strategy in any predefined subgroup. CONCLUSIONS: In patients with atrial fibrillation and congestive heart failure, a routine strategy of rhythm control does not reduce the rate of death from cardiovascular causes, as compared with a rate-control strategy. (ClinicalTrials.gov number, NCT00597077.)

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Authors: Roy, D., Talajic, M., Nattel, S., Wyse, D. G., Dorian, P., Lee, K. L., Bourassa, M. G., Arnold, J. M. O., Buxton, A. E., Camm, A. J., Connolly, S. J., Dubuc, M., Ducharme, A., Guerra, P. G., Hohnloser, S. H., Lambert, J., Le Heuzey, J.-Y., O'Hara, G., Pedersen, O. D., Rouleau, J.-L., Singh, B. N., Stevenson, L. W., Stevenson, W. G., Thibault, B., & Waldo, A. L.
Affiliations: Montreal Heart Institute (CA)
Libin Cardiovascular Institute of Alberta (CA)
St. Michael's Hospital (CA)
Duke Medical Center (US)
London Health Sciences Centre (CA)
Rhode Island Hospital (US)
St George's Hospital (GB)
Population Health Research Institute (CA)
Goethe University Frankfurt (DE)
Bispebjerg Hospital (DK)
VA West Los Angeles Medical Center (US)
Brigham and Women's Hospital (US)
University Hospitals Cleveland Medical Center (US)
ORCID: Roy, Denis
Talajic, Mario
Nattel, Stanley
Dorian, Paul
Bourassa, Martial G.
Buxton, Alfred E.
Camm, A. John
Connolly, Stuart J.
Ducharme, Anique
Guerra, Peter G.
Hohnloser, Stefan H.
Lambert, Jean
Pedersen, Ole Dyg
Rouleau, Jean-Lucien
Stevenson, Lynne Warner
Stevenson, William G.
Thibault, Bernard
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2008-06-19
Volume: 358
Issue: 25
Pages: 2667-2677
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejmoa0708789
OpenAlex: W2131260805
Cited by: 1,585
References: 41
Citations by year: 2026: 42 · 2025: 33 · 2024: 69 · 2023: 55 · 2022: 76 · 2021: 86 · 2020: 77 · 2019: 82 · 2018: 96 · 2017: 87 · 2016: 73 · 2015: 75 · 2014: 87 · 2013: 123 · 2012: 114
FWCI: 97.76
Type: journal article
Language: en
Open access: closed
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Digital Access to Libraries (Université catholique de Louvain (UCL), l'Université de Namur (UNamur) and the Université Saint-Louis (USL-B)) (submittedVersion)
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 › Heart Failure Treatment and Management
Keywords: atrial fibrillation, heart failure, rhythm control, rate control, sinus rhythm maintenance, ventricular rate control, cardiovascular mortality, congestive heart failure, stroke, worsening heart failure, left ventricular ejection fraction
MeSH terms: Adrenergic beta-Antagonists, Aged, Amiodarone, Angiotensin-Converting Enzyme Inhibitors, Anti-Arrhythmia Agents, Atrial Fibrillation, Cardiovascular Diseases, Combined Modality Therapy, Digitalis Glycosides, Electric Countershock, Female, Follow-Up Studies, Heart Failure, Heart Rate, Hospitalization, Humans, Male, Middle Aged, Prospective Studies, Ventricular Dysfunction, Left, Kaplan-Meier Estimate

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Rhythm Control versus Rate Control for Atrial Fibrillation and Heart Failure

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