Is rate more important than rhythm in treating atrial fibrillation? No

doi:10.1136/bmj.b3174

Published 21 August 2009, doi:10.1136/bmj.b3174
Cite this as: BMJ 2009;339:b3174

Head to Head

Is rate more important than rhythm in treating atrial fibrillation? No

Andrew R J Mitchell, consultant cardiologist

¹ Jersey Heart and Lung Unit, General Hospital, St Helier, Jersey JE1 3QS

mail@jerseycardiologist.com

Timothy Betts (doi:10.1136/bmj.b3173) argues that focusing onrate will cause less harm to patients, but Andrew Mitchell believesthat achieving sinus rhythm will have better long term results

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

The number of patients with atrial fibrillation continues torise, partly because of the increasing size and age of the populationbut also because of the large number of patients surviving withother potentially arrhythmogenic conditions.¹ Atrial fibrillationhas been shown to be an independent predictor of mortality withodds ratio of 1.5 (95% confidence interval 1.2 to 1.8) in menand 1.9 (95% confidence interval 1.6 to 2.3) in women.² Restoringsinus rhythm is more important than a rate control strategyin persistent atrial fibrillation, and most patients shouldbe offered the chance to have normal rhythm restored.

Three large randomised trials (Atrial Fibrillation Follow-upInvestigation of Rhythm Management (AFFIRM), Rate Control versusElectrical Cardioversion (RACE), and Strategies of Treatmentof Atrial Fibrillation (STAF)) showed no clear mortality benefitof rhythm control over rate control in patients with relativelyasymptomatic atrial fibrillation during two to three years offollow-up.³ ⁴ ⁵ . . . [Full text of this article]