HelixTalk Episode #84 - Rate Rate … Don’t Tell Me! Rate Versus Rhythm Control in Atrial Fibrillation

Date posted: September 18, 2018, 6:00 am

In this episode, we will discuss the advantages and disadvantages of a rate versus rhythm control strategy for atrial fibrillation.

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Key Concepts

1. Older age and heart failure are two of the most common risk factors for atrial fibrillation; however, most atrial fibrillation trials under-represent patients with heart failure.
2. A rate-control strategy involves using B-blockers, non-dihydropyridine calcium channel blockers, and/or digoxin to reduce the ventricular rate and help with the symptoms of palpitations.
3. A rhythm-control strategy involves cardioversion and the use of antiarrhythmic medications to maintain sinus rhythm and prevent the recurrence of atrial fibrillation.
4. There is essentially no long-term clinical difference between a rate versus rhythm control strategy in atrial fibrillation.  Rate control is associated with a reduced risk of hospitalization and utilizes drug therapy that has fewer adverse effects.  Rhythm control may slightly improve exercise tolerance but isn’t effective in many patients and requires very close monitoring.

References

1. Wyse DG, Waldo AL, DiMarco JP, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002 Dec 5;347(23):1825-33.
2. Roy D, Talajic M, Nattel S, et al. Rhythm control versus rate control for atrial fibrillation and heart failure. N Engl J Med. 2008 Jun 19;358(25):2667-77.
3. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014 Dec 2;130(23):2071-104.