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Rate control was not inferior to rhythm control for recurrent persistent atrial fibrillation

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 QUESTION: Is rate control inferior to rhythm control for persistent atrial fibrillation (AF)?


Randomised {allocation concealed*}, blinded {outcome assessors and monitoring committee},* controlled, non-inferiority trial with mean follow up of 2.3 years (Rate Control vs Electrical Cardioversion for Persistent Atrial Fibrillation [RACE] Study).


31 centres in the Netherlands.


522 patients (mean age 68 y, 63% men) with recurrent persistent AF or flutter, 1–2 electrical cardioversions during the previous 2 years, and no contraindications to oral anticoagulation. Exclusion criteria were arrhythmia lasting >1 year, New York Heart Association class IV heart failure, current or previous treatment with amiodarone, or a pacemaker. All patients were included in the analysis.


256 patients were allocated to rate control, which comprised digitalis, a non-dihydropyridine calcium channel blocker, and a β blocker, alone or in combination. Target resting heart rate was <100 beats/minute. 266 patients were allocated to rhythm control and had electrical cardioversion without previous treatment …

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  • Sources of funding: Center for Health Care Insurance; Interuniversity Cardiology Institute; 3M Pharma.

  • For correspondence: Dr IC Van Gelder, University Hospital, Groningen, The Netherlands. i.c.van.gelder{at}

  • Abstract and commentary also appear in ACP Journal Club.

  • * See glossary.

  • Information provided by author.