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Therapeutics
Rhythm control strategies were not better than rate control strategies for atrial fibrillation
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https://doi.org/10.1136/ebm.8.5.140

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    (2002) N Engl J Med 347, 1825. Wyse DG, Waldo AL, DiMarco JP, et al.. A comparison of rate control and rhythm control in patients with atrial fibrillation.. ;. :. –33.
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 QUESTION: Is a long term rate control strategy as effective as a rhythm control strategy for atrial fibrillation (AF)?

    Design

    Randomised {allocation concealed*}†, blinded {outcome assessors and monitoring committee}†,* controlled trial with a mean follow up of 3.5 years (Atrial Fibrillation Follow up Investigation of Rhythm Management [AFFIRM] study).

    Setting

    213 clinical sites in North America.

    Patients

    4060 patients who were ≥65 years of age (mean age 70 y, 61% men) or had other risk factors for stroke or death; had AF that was likely to be recurrent, likely to cause illness or death, and warranted long term treatment; and had no contraindications to anticoagulants. Follow up was 98%.

    Intervention

    2027 patients were allocated to rate control using the following drugs alone or in combination as selected by the treating physician: β blockers, calcium channel blockers (verapamil and diltiazem), or digoxin. Target heart rate was ≤80 beats/min at rest and ≤110 beats/minute during the 6 minute walk test. Continuous …

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