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

https://doi.org/10.1136/ebm.8.5.141

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    (2002) N Engl J Med 347, 1834. Van Gelder IC, Hagens VE, Bosker HA, et al.. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation.. ;. :. –40.
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 QUESTION: Is rate control inferior to rhythm control for persistent atrial fibrillation (AF)?

    Design

    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).

    Setting

    31 centres in the Netherlands.

    Patients

    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.

    Intervention

    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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