Rate-Control or Rhythm-Contol: Where do we stand?

L, Testa and G, Trotta and A, Dello Russo and M, Casella and G, Pelargonio and F, Andreotti and F, Bellocci (2005) Rate-Control or Rhythm-Contol: Where do we stand? [Journal (Paginated)]

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Atrial fibrillation is the most common sustained rhythm disturbance and its prevalence is increasing worldwide due to the progressive aging of the population. Current guidelines clearly depict the gold standard management of acute symptomatic atrial fibrillation but the best-long term approach for first or recurrent atrial fibrillation is still debated with regard to quality of life, risk of new hospitalizations, and possible disabling complications, such as thromboembolic stroke, major bleeds and death. Some authors propose that regaining sinus rhythm in all cases, thus re-establishing a physiologic cardiac function not requiring a prolonged antithrombotic therapy, avoids the threat of intracranial or extracranial haemorrhages due to Vitamin K antagonists or aspirin. On the contrary, advocates of a rate control approach with an accurate antithrombotic prophylaxis propose that such a strategy may avoid the risk of cardiovascular and non cardiovascular side effects related to antiarrhythmic drugs. This review aims to explore the state of our knowledge in order to summarize evidences and issues that need to be furthermore clarified.

Item Type:Journal (Paginated)
Keywords:atrial fibrillation, rate control, rhythm control, secondary prevention
Subjects:JOURNALS > Indian Pacing and Electrophysiology Journal
ID Code:4596
Deposited By:Indian Pacing and Electrophysiology, Journal
Deposited On:12 Nov 2005
Last Modified:11 Mar 2011 08:56

References in Article

Select the SEEK icon to attempt to find the referenced article. If it does not appear to be in cogprints you will be forwarded to the paracite service. Poorly formated references will probably not work.

1. Fuster V, Ryden LE. ACC/AHA/ESC Guidelines for the Management of Patients With Atrial Fibrillation. A report of the American College of Cardiology/American Heart Association task force on practice guidelines and the European Society of Cardiology committee for practice guidelines and policy conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation). J Am Coll Cardiol 2001;38:1265i-lxx.

2. Benjamin EJ, Levy D, Vaziri SM, D’Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA 1994;271:840-4.

3. Benjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation. 1998 Sep 8;98(10):946-52.

4. Saxena R, Lewis S, Berge E, Sandercock PA, Koudstaal PJ. Risk of early death and recurrent stroke and effect of heparin in 3169 patients with acute ischemic stroke and atrial fibrillation in the international stroke Trial. Stroke 2001;32:2333-7.

5. Levy S, Maarek M, Coumel et al. Characterization of different subsets of atrial fibrillation in general practice in France: the ALFA study. The College of French Cardiologists. Circulation 1999;99:3028-35.

6. Jung w, Luderitz B. Quality of life of Atrial Fibrillation. J Cardiovasc Electrophysiol 1998;9:S177-86.

7. Savelieva I, Paquette M, Dorian P et al. Quality of life in patients with silent atrial fibrillation. Heart 2001;85:216-7.

8. Dorian P, Jung W, Newman D et al. The impairment of health related quality of life in patients with intermittent atrial fibrillation : implications for the assessment of investigational therapy. J Am Coll Cardiol 2000;36:1303-19.

9. Brodsky MA, Chun JG, Podrid PJ, Douban S, Allen BJ, Cygan R. Regional attitudes of generalists, specialists, and sub specialists about management of atrial fibrillation. Arch Intern Med 1996;156:2553-62

10. Redfield MM, Kay GN, Jenkins LS, Miannulli M, Jensen DN, Ellenbogen KA. Tachycardia related cardiomyopathy: a common cause of ventricular dysfunction in patients with atrial fibrillation referred for atrioventricular ablation. Mayo Clin Proc 2000;75:790-5.

11. Petersen P, Kastrup J, Brinch K, Godtfredsen J, Boysen G. Relation between left atrial dimension and duration of atrial fibrillation. Am J Cardiol 1987;60:382-4.

12. Gerhard Hindricks, Christopher Piorkowski, Hildegard Tanner, Richard Kobza, Jin-Hong Gerds-Li, Corrado Carbucicchio, and Hans Kottkamp. Perception of Atrial Fibrillation Before and After Radiofrequency Catheter Ablation: Relevance of Asymptomatic Arrhythmia Recurrence. Circulation 2005;112 307-313.

13. Hart RG, Benavente O, Mc Bride R; Pearce LA. Antithrombotic therapy to prevent stroke in patients with atrial fibrillation: a meta-analysis. Ann Intern Med. 1999;131:492-501.

14. Taylor FC, Cohen H, Ebrahim S. Systematic review of long term anticoagulation or antiplatelet treatment in patients with nonrheumatic atrial fibrillation. BMJ 2001;322:321-6.

15. Julian DG, Camm AJ, Frangin G, et al Randomised trial of effect of amiodarone on mortality in patients with left ventricular dysfunction after recent myocardial infarction: EMIAT. Lancet . 1997;349:667-674.

16. Causes of death in the Antiarrhythmics Versus Implantable Defibrillators (AVID) trials. J. Am Coll Cardiol. 1999;34:1552-1559.

17. Bardy GH, Lee KL, Mark DB et al. Amiodarone or an implantable Cardioverter-Defibrillator for Congestive Heart Failure. N Engl J Med 2005; 352: 225-236.

18. Hejna M, Raderer M, Zielinski CC. Inhibition of metastases by anticoagulants. J Natl Cancer Inst. 1999;91:22-36.

19. Hagens VE, Ranchor AV, Van Sonderen E, Bosker HA, Kamp O, Tijssen JGP, Kingma JH, Crijns H, Van Gelder I fort he RACE study group. Effect of Rate or Rhythm control on Quality of life in Persistent atrial fibrillation. JACC 2004;43:241-7.

20. Gronefeld GC, Lilienthal J, Kuck KH, Hohnosler SH, for the Pharmacological intervention in atrial fibrillation (PIAF) study investigators. Impact of rate versus rhythm control on quality of life in patients with persistent atrial fibrillation. Eur Heart J 2003;24:1430-1436.

21. Rawles JM. What is meant by a “controlled” ventricular rate in atrial fibrillation? Br Heart J 1990 63:157-61.

22. Farshi R, kistner D, Sama JSM, et al. Ventricular rate control in chronic atrial fibrillation during daily activity and programmed exercise: a cross over open label study of five drug regimens. J Am Coll Cardiol 1999;33:304-310.

23. Pnadis JP, Morganroth J, Baessler C, Effectiveness and safety of oral verapamil to contrl exercise-induced tachycardia in patients with atrial fibrillation receiving digitalis. Am J Cardiol 1983;52:1197-201.

24. Rodney H, Falk MD. Atrial fibrillation. N Engl J Med 2001;344:1067-78.

25. Daoud EG, Weiss R, Bahu M, Knight BP, Bogun F, Goyal R, Harvey M, Strickberger SA, Man KC, Morady F. Effect of irregular ventricular rhythm on cardiac output. Am J Cardiol 1996;78:1433-36.

26. Brignole M, Menozzi C, Gianfranchi L, Musso G, Mureddu R, Bottoni N, Lolli G. Assessment of atrioventricular junction ablation and VVIR pacemaker versus pharmacological treatment in patients with heart failure and chronic atrial fibrillation: a randomized controlled study. Circul 1998;98:953-60.

27. Ozcan C, Jahangir A, Friedman PA, Patel PJ, Munger TM, Rea RF, Lloyd MA, Packer DL, Hodge DO, Gersh BJ, Hammil SC, Shen WK. Long term survival after ablation of the atrioventricula node and implantation of permanent pacemaker in patients with atrial fibrillation. N Engl J Med 2001;3441:1043-51.

28. Proclemer A, Della Bella P, Tondo C, Facchin D, Carbucicchio C, Riva S, Fioretti P. Radiofrequency ablation of atrioventricular junction and pacemaker implantation versus modulation of atrioventricular conduction in drug refractory atrial fibrillation. Am J Cardiol. 1999 15;83(10):1437-42.

29. Letelier LM, Udol K, Ena J, Weaver B, Guyatt GH. Effectiveness of amiodarone for conversion of atrial fibrillation to synus rhythm. Arch Intern Med 2003;163:777-85.

30. Martin DO. Managing chronic atrial fibrillation: strategies to control symptoms and prevent embolism. Cleve Clin J Med 2003;70 Suppl 3: S30-3.

31. Dalzell GW, Anderson J, Adgey AA. Factors determining success and energy requirements for cardioversion of atrial fibrillation. Q J Med 1990;76:903-13.

32. Bertaglia E,D’este D, Zerbo F, Zoppo F, Delise P, Pascotto P. Success of serial external electrical cardioversion of persistent atrial fibrillation in maintaining sinus rhythm. A randomized study. Eur Heart J 2002;23:1522-8.

33. Dittrich HC, Erickson JS, Schneiderman T, Blacky AR, Savides T, Nicod PH. Echocardiographic and clinical predictors for outcome of elective cardioversion of atrial fibrillation. Am J Cardiol 1989;63:193-7.

34. Asher CR, Klein AL, The ACUTE trial. Transoesophageal echocardiography to guide electrical cardioversion in atrial fibrillation. Assessment of Cardioversion Using Transoesophageal Echocardiography. Cleve Clin J Med 2002;69:713-18.

35. Haissaguerre M, Jais P, Shah DC, Takahashi A, Hocini M, Quiniou G, Garrigue S, Le Moroux A, Le Metayer P, Clementy J. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Eng J Med 1998;339:659-66.

36. Saad EB, Marrouche NF, Saad CP, Ha E, Bash D, White RD, Rhodes J, Prieto L, Martin DO, Saliba WI, Schweikert RA, Natale A. Pulmonary vein stenosis after catheter ablation of atrial fibrillation: emergence of a new clinical syndrome. Ann Intern Med 2003 15;138(8):634-8.

37. Pappone C, Rosanio S, Augello G, Gallus G, Vicedomini G, Mazzone P, Gulletta S, Gugliotta F, Pappone A, Santinelli V, Tortoriello V, Sala S, Zangrillo A, Crescenzi G, Benussi S, Alfieri O. Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation: outcomes from a controlled nonrandomized long-term study. J Am Coll Cardiol. 2003;42(2):185-97.

38. Cooper JM, Katcher MS, Orlow MV. Implantable device for the treatment of atrial fibrillation. N Eng J Med 2002; 346: 2062-68.

39. Ad N, Cox JL. The Maze procedure for the treatment of atrial fibrillation: a minimally invasive approach. J Card Surg. 2004;19(3):196-200.

40. Hohnloser SH, Kuck KH, Lilienthal J. Rhythm or rate control in atrial fibrillation- Pharmacological intervention in atrial fibrillation (PIAF): A randomized trial. Lancet 2000;356:1789-1794.

41. Carlsoon J, Miketic S, Windeler J, et al. Randomized trial of rate control versus rhythm control in persistent atrial fibrillation. Strategies of treatment of atrial fibrillation (STAF) study. J Am Coll Cardiol 2003;41:1690-6.

42. Van Gelder IC, Hagens VE, Bosker HA, et al. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med 2002;347: 834-1840.

43. Wyse DG, Waldo AL, Di Marco JP, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 2002;347:1825-1833.

44. Opolski G, Torbicki A, Kosior D, et al. Rhythm control versus rate control in patients with persistent atrial fibrillation. Results of the HOT CAFÉ Polish study. Kardiol Pol 2003;59:1-16.

45. Vora A, Karnad D, Goyal V, Naik A, Gupta A, Lokhandwala Y, Kulkarni H, Singh B. Control of rate versus rhythm in rheumatic atrial fibrillation: a randomized study. Indian Heart J. 2004;56(2):110-6.

46. Yamashita T, Ogawa S, Aizawa Y, Atarashi H, Inoue H, Ohe T, Okumura K, Kato T, Kamakura S, Kumagai K, Kurachi Y, Kodama I, Koretsune Y, Saikawa T, Sakurai M, Sugi K, Nakaya H, Nakayama T, Hirai M, Fukatani M, Mitamura H, Yamazaki T; J-RHYTHM Investigators. Investigation of the optimal treatment strategy for atrial fibrillation in Japan. Circ J. 2003;67(9):738-41. 23)

47. Rationale and design of a study assessing treatment strategies of atrial fibrillation in patients with heart failure: The Atrial Fibrillation and Congestive Heart Failure (AF-CHF) trial. Am Heart J 2002;144:597-607.

48. Testa L, Biondi-Zoccai GG, Russo AD, Bellocci F, Andreotti F, Crea F. Rate-control vs. rhythm-control in patients with atrial fibrillation: a meta-analysis. Eur Heart J. 2005 May 4; [Epub ahead of print].

49. Patsopoulos NA, Analatos AA, Ioannidis JPA. Relative citation impact of various study designs in health sciences. JAMA 2005; 293:2362-2366.

50. Steinberg JS, Sadaniantz A, Kron J, et al. Analysis of cause specific mortality in the atrial fibrillation follow up investigation of rhythm management (AFFIRM) study. Circulation. 2004:27; 109(16): 1973-1980.

51. The AFFIRM investigators. Relationships between sinus rhythm, treatment, and survival in the atrial fibrillation follow up investigation of rhythm management (AFFIRM) study. Circulation. 2004:30;109(12):1509-13.


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