Rhythm Control Versus Rate Control in Atrial Fibrillation

Rhythm Control Versus Rate Control in Atrial Fibrillation Posted By:
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It is a well-established fact that atrial fibrillation (AF) is the most common sustained arrhythmia; it can cause significant physical and emotional symptoms and interfere with the patient's quality of life if therapeutic intervention is not undertaken. The overriding goals of therapy for AF are symptom control and prevention of thromboembolism. When the patient is not at high risk for a catastrophic cardiovascular event, the rhythm and rate control approaches are associated with similar rates of mortality and serious morbidity.

When you are trying to decide whether rhythm or rate control will be more beneficial, take into consideration the patient's symptoms, their duration of experiencing AF, and their cardiovascular risk.

For newly diagnosed/high-risk patients with AF (especially if the patient is symptomatic), a rhythm control strategy is suggested. This must be initiated within 12 months of onset.

Patients at high risk are defined as:

  • Patients >75 years of age
  • Previous cardiovascular accident or transient ischemic attack
  • Any 2 of the following: female gender; age >65 years; presence of heart failure, hypertension, diabetes, severe coronary artery disease, chronic kidney disease, or left ventricular hypertrophy

All other patients may utilize either a rate or rhythm control strategy after examining their cardiovascular risks, symptom status, and the duration of their AF.

Notably:

  • A rhythm control strategy may be best for patients that fail on a rate control strategy and have persistent clinically significant symptoms, those with a history of heart failure, or young patients
  • A rate control strategy may be best for asymptomatic patients or anxious patients that decline a rhythm control strategy secondary to possible side effects of medications or potential complications of catheter ablation
References
  • Kirchhof P, et al. Early rhythm-control therapy in patients with atrial fibrillation. NEJM. 2020;383:1305.

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Filed under: Cardiometabolic

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