Rate versus rhythm control in atrial fibrillation

OBJECTIVE: To determine whether rate control is a viable initial treatment approach in persistent atrial fibrillation (AF) through the evaluation of recently completed trials comparing rate and rhythm control. DATA SOURCES: Biomedical literature was obtained through MEDLINE (1966-December 2003) and the Iowa database. STUDY SELECTION AND DATA EXTRACTION: Articles identified from the biomedical literature search were reviewed and included if deemed relevant. DATA SYNTHESIS: Currently available data suggest that rate control is not inferior to rhythm control in patients with persistent AF with respect to mortality. Rate control also reduces hospitalizations and the occurrence of proarrhythmias. No significant difference was observed between treatments with respect to thromboembolism and strokes. CONCLUSIONS: Due to the increased incidence of hospitalizations and antiarrhythmic adverse effects associated with rhythm control, rate control is a reasonable first-line strategy in the treatment of recurrent AF, especially in elderly patients who are asymptomatic or mildly symptomatic. Further studies are needed to clearly define the role of rate control in younger patients.