A systematic review «de Denus S, Sanoski CA, Carlsson J, Opolski G, Spinler SA. Rate vs rhythm control in patients with atrial fibrillation: a meta-analysis. Arch Intern Med 2005 Feb 14;165(3):258-62. »1 includied 5 studies with a total of 5 239 subjects with persistent atrial fibrillation (AF) or AF that was considered likely to be recurrent. There was no statistically significant difference in all-cause mortality between the rate and rhythm control groups (OR 0.87, 95% CI 0.74 to 1.02, P=0.09).
A meta-analysis «Testa L, Biondi-Zoccai GG, Dello Russo A, et al. Rate-control vs. rhythm-control in patients with atrial fibrillation: a meta-analysis. Eur Heart J 2005;26(19)2000-6. »2 included 5 studies with a total of 5 239 subjects with AF. A rate-control strategy compared with a rhythm-control approach was associated with a significantly reduced risk of combined endpoint of all cause death and thromboembolic stroke (CEP, OR 0.84, 95% CI 0.73 to 0.98; NNT = 50), and with a trend towards a reduced risk of death (OR 0.87, 95% CI 0.74 to 1.02) and thromboembolic stroke (OR 0.80, 95% CI 0.6 to 1.07).
In a multi-centre trial «Roy D, Talajic M, Nattel S, Wyse DG, Dorian P, Lee KL, Bourassa MG, Arnold JM, Buxton AE, Camm AJ, Connolly SJ, Dubuc M, Ducharme A, Guerra PG, Hohnloser SH, Lambert J, Le Heuzey JY, O'Hara G, Pederse»3 including 1 376 patients with atrial fibrillation, symptoms of congestive heart failure and left ventricular ejection fraction of 35% or less, rhythm control was compared to rate control. Of these patients, 182 (27%) in the rhythm control group died from cardiovascular causes, as compared with 175 (25%) in the rate-control group (HR 1.06, 95% CI 0.86 to 1.30).
RACE «Hagens VE, Ranchor AV, Van Sonderen E, Bosker HA, Kamp O, Tijssen JG, Kingma JH, Crijns HJ, Van Gelder IC, RACE Study Group. Effect of rate or rhythm control on quality of life in persistent atrial fi»4 and PIAF «Hohnloser SH, Kuck KH, Lilienthal J. Rhythm or rate control in atrial fibrillation--Pharmacological Intervention in Atrial Fibrillation (PIAF): a randomised trial. Lancet 2000 Nov 25;356(9244):1789-94»5 studies found no difference in quality of life with rhythm control compared with rate control.
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