Abstract
More than 10 years ago, 7 rate versus rhythm control trials demonstrated that, in patients with paroxysmal and persistent atrial fibrillation (AF), rate control was comparable to rhythm control regarding outcome.1,2 From that moment on, rate control became frontline therapy in older patients with few or acceptable symptoms of AF. Although rate control was an easy-to-perform therapeutic strategy, rate control criteria, and the selection of drugs, as well, were not evidence based. It is interesting that, in the rate versus rhythm control trials, rate-controlling strategies differed significantly. Whereas the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial aimed to achieve heart rates comparable to the heart rates during sinus rhythm, patients included in the Rate Control versus Electric cardioversion for Persistent Atrial Fibrillation (RACE) study were treated with a more lenient approach. Thus far, only 1 randomized clinical trial has been performed evaluating different rate control strategies. The Rate Control Efficacy in Permanent Atrial Fibrillation: a comparison between Lenient and Strict Rate Control II (RACE II) study compared a strict rate control approach with a more lenient rate control approach in patients with permanent AF.3,4 The RACE II trial showed that a lenient rate control approach was not inferior in comparison with a strict rate control approach regarding cardiovascular morbidity and mortality in patients with permanent AF without severe heart failure (HF). Subsequently, the American College of Cardiology, American Heart Association, Heart Rhythm Society, and European Society of Cardiology guidelines adopted a lenient rate control approach as initial strategy in asymptomatic patients as long as the left ventricular function remains preserved.5,6 A more strict rate control approach, however, was recommended in more symptomatic patients or when left ventricular function deteriorates. Article see p 1604 No recommendation can be provided regarding …
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