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Systematic review and meta-analysis
Rate and rhythm control have comparable effects on mortality and stroke in atrial fibrillation but better data are needed
  1. Dipak Kotecha1,2,
  2. Paul Kirchhof1,3
  1. 1Centre for Cardiovascular Sciences, Medical School, University of Birmingham, Birmingham, UK
  2. 2Monash Centre of Cardiovascular Research & Education in Therapeutics, Monash University, Melbourne, Australia
  3. 3Department of Cardiovascular Medicine, Hospital of the University of Münster, Münster, Germany
  1. Correspondence to: Dr Dipak Kotecha, Centre for Cardiovascular Sciences, Medical School, University of Birmingham, Vincent Drive, Birmingham B15 2TT, UK; d.kotecha{at}

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Atrial fibrillation (AF) represents a large and growing burden on cardiovascular healthcare and leads to a substantial impact on quality-of-life, increased cardiovascular events and a doubling of hospitalisation and death rates.1 Unlike many other cardiac conditions, the evidence base for treatment in AF remains patchy with clear gaps relating to a number of clinically important management strategies. Current practice involves three major elements: anticoagulation to prevent stroke or systemic embolism, medications to control heart rate and a decision on whether to restore and maintain sinus rhythm. This systematic review and meta-analysis of tabular data addresses the benefits and risks of adding rhythm control to rate control therapy, considers the preferential method of …

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  • Competing interests DK is the Steering Committee Lead for the β-blockers in Heart Failure Collaborative Group: Individual Patient Data Meta-Analysis.8 PK is a Board member of AFNET, an academic research organisation running trials in atrial fibrillation, and a recipient of research grants from the British Heart Foundation, DFG, Fondation Leducq, the European Union and others. He is also the principal investigator of the investigator-initiated EAST trial.6 A full list of financial disclosures is available on the website of the ESC.

  • Provenance and peer review Commissioned; internally peer reviewed.