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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 …
Footnotes
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Sources of funding: Center for Health Care Insurance; Interuniversity Cardiology Institute; 3M Pharma.
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For correspondence: Dr IC Van Gelder, University Hospital, Groningen, The Netherlands. i.c.van.gelder{at}thorax.azg.nl
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Abstract and commentary also appear in ACP Journal Club.
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↵† Information provided by author.