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Randomised controlled trial
In permanent atrial fibrillation, lenient rate control is not inferior to strict rate control for preventing cardiovascular morbidity and mortality
  1. Brian Olshansky,
  2. Renee M Sullivan
  1. University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  1. Correspondence to Brian Olshansky
    Cardiovascular Division, 200 Hawkins Drive, 4426a JCP, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; brian-olshansky{at}uiowa.edu

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Ventricular rate control remains a reasonable long-term management option for patients with atrial fibrillation (AF), but the optimal rate and best method to achieve it remain uncertain. The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) and Rate Control versus Electrical Cardioversion (RACE) for Persistent AF trials compared rate control and rhythm control strategies in patients with paroxysmal or persistent AF and persistent AF, respectively.1 2 AFFIRM employed a ‘strict’ approach targeting a resting rate <80 beats per minute (bpm) and a rate during moderate exercise <110 bpm. This was difficult to achieve and required frequent medication changes.3 RACE used a ‘lenient’ approach calling for a resting pulse <100 bpm. A pooled retrospective analysis, comparing matched participants in rate control arms of AFFIRM and …

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