Should rhythm control be preferred in younger atrial fibrillation patients?

Abstract

A significant trend towards that rhythm control may be a preferable strategy for younger AF patients was observed in this study.

Atrial Fibrillation: Antiarrhythmic Therapy

“…All-cause mortality was not different between both the treatment groups in the meta-analyses. 8,9 There were also no significant differences in rates of cerebrovascular or systemic thromboembolism, worsening heart failure, or bleeding. Rehospitalization was significantly lower with rate control therapy, with a relative risk of 0.67 (CI: 0.50-0.90, P = 0.007).…”

“…Although current evidence from multiple randomized controlled trials does not convey a mortality benefit for the maintenance of SR, meta-analyses suggest that rhythm control may provide an advantage to young subgroups. 8,9 Compared with evenly spaced ventricular activation, AF-mediated irregular ventricular activation at the same rate decreases cardiac output by 15%, and persistently elevated ventricular rates can produce a tachycardia-induced cardiomyopathy. [10][11][12] Mechanistically, cardioversion and maintenance of SR causes reverse remodeling of atrial enlargement induced by AF and may provide some advantage to a rhythm control strategy.…”

“…Two groups each analyzed 10 trials that directly compared both the strategies. 8,9 Correspondingly, 7867 patients and 7876 patients were analyzed. Most of the data were from AFFIRM, RACE, J-RHYTHM, and AF-CHF, but these analyses also included smaller 150-250 patient trials that studied young patients with rheumatic AF.…”

“…However, when the analysis was limited to patients younger than 65 years, rate control had an increased relative risk of all-cause mortality of 3.03 (CI: 1.59-5.75, P = 0.0007) and an increased risk of the composite outcome of mortality, worsening heart failure, thromboembolism, and bleeding with an odds ratio of 1.89 (CI: 1.28-2.86, P = 0.002), mainly driven by an increased risk of heart failure. 8,9 Dr. Joseph S. Alpert: As noted throughout this article, the decision for rate control vs rhythm control should be individualized from patient to patient. Patients should be completely informed concerning the risks and benefits of anticoagulant therapy and the final decision concerning its use is then negotiated.…”

Atrial Fibrillation: Current Problems and Prospects of Medical Care, Treatment and Prevention

“…[19], сравнив в метаанализе стратегии «контроль ритма» и «контроль частоты» по суммам осложнений при сопоставимом общем их количестве (11,03% против 11,47% в год), отметили, что у боль-ных моложе 65 лет контроль частоты сопровождался двукратно большей (8,74% против 4,8%) суммой осложнений, чем контроль ритма, что позволило ав-торам сделать заключение, что контроль ритма может являться предпочтительной стратегией для молодых больных.…”