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

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

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  1. Andrew R J Mitchell, consultant cardiologist
  1. 1Jersey Heart and Lung Unit, General Hospital, St Helier, Jersey JE1 3QS
  1. mail{at}jerseycardiologist.com

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

    The number of patients with atrial fibrillation continues to rise, partly because of the increasing size and age of the population but also because of the large number of patients surviving with other potentially arrhythmogenic conditions.1 Atrial fibrillation has been shown to be an independent predictor of mortality with odds ratio of 1.5 (95% confidence interval 1.2 to 1.8) in men and 1.9 (95% confidence interval 1.6 to 2.3) in women.2 Restoring sinus rhythm is more important than a rate control strategy in persistent atrial fibrillation, and most patients should be offered the chance to have normal rhythm restored.

    Rate versus rhythm

    Three large randomised trials (Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM), Rate Control versus Electrical Cardioversion (RACE), and Strategies of Treatment of Atrial Fibrillation (STAF)) showed no clear mortality benefit of rhythm control over rate control in patients with relatively …

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