Rate control in patients with chronic atrial fibrillation

Abstract

Since the early description of atrial fibrillation (AF) in an elegant lecture at the University College Hospital in London by Thomas Lewis in 1912, 1 Lewis T. A lecture on the evidences of auricular fibrillation, treated historically. Br Med J 1912;218:57–60 Google Scholar it has been the overall perception that heart rate at rest in patients with AF should be controlled at a level close to the heart rate in patients with normal sinus rhythm. Studies have found, however, that this form of treatment in some patients may lead to a decreased functional capacity without offering any benefits. 2 Lewis R.V. Irvine N. McDewitt D.G. Relationship between heart rate, exercise tolerance and cardiac output in AF the effects of treatment with digoxin, verapamil and diltiazem. Eur Heart J. 1988; 9: 777-781 Crossref PubMed Google Scholar , 3 Rawles J.M. What is meant by a “controlled” ventricular response in AF?. Br Heart J. 1990; 63: 157-161 Crossref PubMed Scopus (148) Google Scholar , 4 Lundström T. Moor E. Ryden L. Differential effects of xamoterol and verapamil on ventricular rate regulation in patients with chronic AF. Am Heart J. 1992; 124: 917-923 Abstract Full Text PDF PubMed Scopus (16) Google Scholar Using the results from recent multicenter trials, which suggest that rate control is a valid option for many patients with chronic AF, 5 Hohnloser S.H. Kuck K.-H. Lilienthal J. Rhythm or rate control in atrial fibrillation —Pharmacological Intervention in Atrial Fibrillation (PIAF) a randomized trial. Lancet. 2000; 356: 1789-1794 Abstract Full Text Full Text PDF PubMed Scopus (1052) Google Scholar , 6 AFFIRM InvestigatorsA comparison of rate control and rhythm control in patients with AF. N Engl J Med. 2002; 347: 1825-1833 Crossref PubMed Scopus (3647) Google Scholar , 7 Van Gelder I.C. Hagens V.E. Bosker H.A. Kingma J.H. Kamp O. Kingma T. Said S.A. Darmanata J.I. Timmermans A.J.M. Tijssen J.G.P. Crijns H.J.G.M. A comparison of heart rate control and rhythm control in patients with recurrent persistent AF. N Engl J Med. 2002; 347: 1834-1840 Crossref PubMed Scopus (1982) Google Scholar , 8 Carlsson J. Miketic S. Windeler J. Cuneo A. Haun S. Micus S, Walter S, Tebbe U, for the STAF Investigators. Randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation (STAF). J Am Coll Cardiol. 2003; 41: 1690-1696 Abstract Full Text Full Text PDF PubMed Scopus (809) Google Scholar it would then seem appropriate to review the pertinent data for a discussion of what constitutes an appropriate heart rate in patients with AF and how best to accomplish that rate.