Clinical Trial Registration Information: N/A.
Is Rhythm-Control Superior to Rate-Control in Patients with Atrial Fibrillation and Diastolic Heart Failure?
Article first published online: 13 JUL 2010
©2010, Wiley Periodicals, Inc.
Annals of Noninvasive Electrocardiology
Volume 15, Issue 3, pages 209–217, July 2010
How to Cite
Kong, M. H., Shaw, L. K., O’Connor, C., Califf, R. M., Blazing, M. A. and Al-Khatib, S. M. (2010), Is Rhythm-Control Superior to Rate-Control in Patients with Atrial Fibrillation and Diastolic Heart Failure?. Annals of Noninvasive Electrocardiology, 15: 209–217. doi: 10.1111/j.1542-474X.2010.00365.x
Funding Sources: Funded by a Peer-reviewed grant from the Duke Clinical Research Institute and Melissa H. Kong was funded by the Barton F. Haynes Early Career Research Grant.
- Issue published online: 13 JUL 2010
- Article first published online: 13 JUL 2010
- atrial fibrillation;
- diastolic heart failure;
Background: Although no clinical trial data exist on the optimal management of atrial fibrillation (AF) in patients with diastolic heart failure, it has been hypothesized that rhythm-control is more advantageous than rate-control due to the dependence of these patients’ left ventricular filling on atrial contraction. We aimed to determine whether patients with AF and heart failure with preserved ejection fraction (EF) survive longer with rhythm versus rate-control strategy.
Methods: The Duke Cardiovascular Disease Database was queried to identify patients with EF > 50%, heart failure symptoms and AF between January 1,1995 and June 30, 2005. We compared baseline characteristics and survival of patients managed with rate- versus rhythm-control strategies. Using a 60-day landmark view, Kaplan-Meier curves were generated and results were adjusted for baseline differences using Cox proportional hazards modeling.
Results: Three hundred eighty-two patients met the inclusion criteria (285 treated with rate-control and 97 treated with rhythm-control). The 1-, 3-, and 5-year survival rates were 93.2%, 69.3%, and 56.8%, respectively in rate-controlled patients and 94.8%, 78.0%, and 59.9%, respectively in rhythm-controlled patients (P > 0.10). After adjustments for baseline differences, no significant difference in mortality was detected (hazard ratio for rhythm-control vs rate-control = 0.696, 95% CI 0.453–1.07, P = 0.098).
Conclusions: Based on our observational data, rhythm-control seems to offer no survival advantage over rate-control in patients with heart failure and preserved EF. Randomized clinical trials are needed to verify these findings and examine the effect of each strategy on stroke risk, heart failure decompensation, and quality of life.
Ann Noninvasive Electrocardiol 2010;15(3):209–217