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Therapeutics
Rate and rhythm control showed similar symptom improvement in atrial fibrillation

https://doi.org/10.1136/ebm.6.4.113

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    (2000) Lancet 356, 1789. Hohnloser SH, Kuck KH, Lilienthal J, for the PIAF Investigators.. Rhythm or rate control in atrial fibrillation—pharmacological intervention in atrial fibrillation (PIAF): a randomised trial.. Nov 25;. :. –94.
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 QUESTION: In patients with atrial fibrillation (AF), how do rate control and sinus rhythm control compare in improving symptoms?

    Design

    Randomised (unclear allocation concealment*), unblinded,* controlled trial with 12 months follow up.

    Setting

    21 centres in Germany.

    Patients

    252 patients who were 18–75 years of age (mean age 60 y, 73% men) and who presented with symptomatic persistent AF between 7 and 360 days in duration. Exclusion criteria included congestive heart failure, New York Heart Association class IV; unstable angina; acute myocardial infarction in the previous 30 days; AF with mean rate <50 beats/minute; AF in conjunction with the Wolff Parkinson White syndrome; and coronary artery bypass graft or valve replacement in the previous 3 months. Follow up was 96%.

    Intervention

    Patients were allocated to rate control (n=125) or to rhythm control (n=127). In rate control, the therapeutic goal was to achieve an improvement in symptoms by controlling ventricular rate with the use …

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    Footnotes

    • Sources of funding: Sanofil Synthelabo Research and Parke Davis Research.

    • For correspondence: Dr S H Hohnloser, Department of Medicine, Division of Cardiology, J W Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.

    • ↵* See glossary.