As such , evidence was insufficient to recommend rhythm or rate control as the first-line therapy for AF in older adults .
Atrial fibrillation ( AF ) is highly prevalent in older adults and has been associated with increased morbidity and mortality .
To reduce this AF-related morbidity in older adults , antiarrhythmic drugs ( AADs ) are regularly used for rhythm control , assuming that increasing time in sinus rhythm reduces AF-related morbidity .
However , whether AADs can improve clinical outcomes in older adults remains unclear because of the increased risk for adverse drug events compared with rate control .
The aim of this study was to determine the impact of rhythm control versus rate control on clinical outcomes in older adults with AF .
A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation.
BACKGROUND Maintenance of sinus rhythm is the main therapeutic goal in patients with atrial fibrillation . However , recurrences of atrial fibrillation and side effects of antiarrhythmic drugs offset the benefits of sinus rhythm . We hypothesized that ventricular rate control is not inferior to the maintenance of sinus rhythm for the treatment of atrial fibrillation . METHODS We r and omly assigned 522 patients who had persistent atrial fibrillation after a previous electrical cardioversion to receive treatment aim ed at rate control or rhythm control . Patients in the rate-control group received oral anticoagulant drugs and rate-slowing medication . Patients in the rhythm-control group underwent serial cardioversions and received antiarrhythmic drugs and oral anticoagulant drugs . The end point was a composite of death from cardiovascular causes , heart failure , thromboembolic complications , bleeding , implantation of a pacemaker , and severe adverse effects of drugs . RESULTS After a mean ( + /-SD ) of 2.3+/-0.6 years , 39 percent of the 266 patients in the rhythm-control group had sinus rhythm , as compared with 10 percent of the 256 patients in the rate-control group . The primary end point occurred in 44 patients ( 17.2 percent ) in the rate-control group and in 60 ( 22.6 percent ) in the rhythm-control group . The 90 percent ( two-sided ) upper boundary of the absolute difference in the primary end point was 0.4 percent ( the prespecified criterion for noninferiority was 10 percent or less ) . The distribution of the various components of the primary end point was similar in the rate-control and rhythm-control groups . CONCLUSIONS Rate control is not inferior to rhythm control for the prevention of death and morbidity from cardiovascular causes and may be appropriate therapy in patients with a recurrence of persistent atrial fibrillation after electrical cardioversion
As such , evidence was insufficient to recommend rhythm or rate control as the first-line therapy for AF in older adults .
Atrial fibrillation ( AF ) is highly prevalent in older adults and has been associated with increased morbidity and mortality .
To reduce this AF-related morbidity in older adults , antiarrhythmic drugs ( AADs ) are regularly used for rhythm control , assuming that increasing time in sinus rhythm reduces AF-related morbidity .
However , whether AADs can improve clinical outcomes in older adults remains unclear because of the increased risk for adverse drug events compared with rate control .
The aim of this study was to determine the impact of rhythm control versus rate control on clinical outcomes in older adults with AF .