Is rate more important than rhythm in treating atrial fibrillation? Yes

doi:10.1136/bmj.b3173

Published 21 August 2009, doi:10.1136/bmj.b3173
Cite this as: BMJ 2009;339:b3173

Head to Head

Is rate more important than rhythm in treating atrial fibrillation? Yes

Timothy R Betts, consultant cardiologist and electrophysiologist

¹ Department of Cardiology, John Radcliffe Hospital, Oxford OX3 9DU

EP.doctors@orh.nhs.uk

Timothy Betts argues that focusing on rate will cause less harmto patients, but Andrew Mitchell (doi:10.1136/bmj.b3174) believesthat achieving sinus rhythm will have better long term results

The first 150 words of the full text of this article appear below.

Both sides of the debate on whether to control rhythm or rateagree that sinus rhythm is better than atrial fibrillation.¹If a strategy to control rhythm could guarantee to be efficacious,cost effective, and have no risk of adverse events, there wouldbe no argument. Unfortunately, this is rarely the case. Rhythmcontrol is difficult to achieve and initially requires the useof potentially toxic drugs. If the objective is to "first dono harm," rate control is more important.

Six randomised controlled trials comparing rate and rhythm controlhave clearly shown that mortality (whether as a primary or compositeend point) is not reduced with rhythm control.² ³ ⁴ ⁵ ⁶ ⁷ Inthe two largest of these there was even a trend to increasedmortality in the rhythm control group.³ ⁴ This is probably becauseof the potential toxicity of rhythm control drugs and the inappropriatewithdrawal of warfarin in the rhythm control . . . [Full text of this article]