A Comparison of Rate Control and Rhythm Control in Patients with Atrial Fibrillation
New England Journal of MedicinePublished 5 December 2002Open access
D G Wyse, A.L. Waldo, John Dimarco, M J Domanski, Yves Rosenberg, Eleanor Schron
Citations4,376
SJR quartileQ1
SJR score19.08
SNIP13.47
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveWill appear once the snapshot is generated
MethodsWill appear once the snapshot is generated
PopulationWill appear once the snapshot is generated
Sample sizeWill appear once the snapshot is generated
OutcomesWill appear once the snapshot is generated
ResultsWill appear once the snapshot is generated
LimitationsWill appear once the snapshot is generated
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
Management of atrial fibrillation with the rhythm-control strategy offers no survival advantage over the rate- control strategy, and there are potential advantages, such as a lower risk of adverse drug effects, with the rate -control strategy.
Abstract
Management of atrial fibrillation with the rhythm-control strategy offers no survival advantage over the rate-control strategy, and there are potential advantages, such as a lower risk of adverse drug effects, with the rate-control strategy. Anticoagulation should be continued in this group of high-risk patients.
Keywords
Medicine
Journal of Psychiatric Research“Mini-mental state”
86,858 Citations1975Marshal F. Folstein, Susan E. Folstein +1 more
A simplified, scored form of the cognitive mental status examination, the “Mini-Mental State” (MMS) which includes eleven questions, requires only 5-10 min to administer, and is therefore practical to use serially and routinely.
Journal of the Royal Statistical Society Series B (Statistical Methodology)Regression Models and Life-Tables
39,259 Citations1972D. R. Cox
Journal of the American Statistical AssociationNonparametric Estimation from Incomplete Observations
7,727 Citations1958Edward L. Kaplan, Paul Meier
StrokeAtrial fibrillation as an independent risk factor for stroke: the Framingham Study.
7,462 Citations1991Philip A. Wolf, Robert D. Abbott +1 more
The data suggest that the elderly are particularly vulnerable to stroke when atrial fibrillation is present, and the effects of hypertension, coronary heart disease, and cardiac failure on the risk of stroke became progressively weaker with increasing age.
JAMAPrevalence of Diagnosed Atrial Fibrillation in Adults
6,226 Citations2001Alan S. Go, Elaine M. Hylek +5 more
It is confirmed that atrial fibrillation is common among older adults and provides a contemporary basis for estimates of prevalence in the United States.
CirculationImpact of Atrial Fibrillation on the Risk of Death
4,587 Citations1998Emelia J. Benjamin, Philip A. Wolf +4 more
There was a significant AF-sex interaction: AF diminished the female advantage in survival and AF remained significantly associated with excess mortality, with about a doubling of mortality in both sexes in subjects free of valvular heart disease and preexisting cardiovascular disease.
BiometricsA Multiple Testing Procedure for Clinical Trials
3,349 Citations1979Peter C. O’Brien, Thomas R. Fleming
The overall size of the procedure is shown to be controlled with virtually the same accuracy as the single sample chi-square test based on N(m1 + m2) observations and the power is found to bevirtually the same.
CirculationStroke Prevention in Atrial Fibrillation Study. Final results.
1,712 Citations1991
Aspirin and warfarin are both effective in reducing ischemic stroke and systemic embolism in patients with atrial fibrillation and patients with nonrheumatic atrialfibrillation who can safely take either aspirin or warfarIn should receive prophylactic antithrombotic therapy to reduce the risk of stroke.
NeurologyEpidemiologic assessment of chronic atrial fibrillation and risk of stroke
1,546 Citations1978Philip A. Wolf, Thomas R. Dawber +2 more
Controlled trials of anticoagulants or antiarrhythmic agents in persons with chronic AF may demonstrate if strokes can be prevented in this highly susceptible group.
The American Journal of MedicineThe natural history of atrial fibrillation: Incidence, risk factors, and prognosis in the manitoba follow-up study
1,474 Citations1995Andrew D. Krahn, Jure Manfreda +3 more
The incidence of atrial fibrillation in men increases with advancing age, and clinical cardiac abnormalities, particularly recent ischemic heart disease and hypertension, are strongly associated with increased risk for atrialfibrillation.
Journal of the American College of CardiologyACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary
1,364 Citations2001Valentı́n Fuster, Lars Rydén +32 more
New guidelines for management of supraventricular tachyarrhythmia characterized by uncoordinated atrial activation with consequent deterioration of atrial mechanical function are published.
Archives of Internal MedicineAtrial fibrillation: a major contributor to stroke in the elderly. The Framingham Study
1,213 Citations1987Philip A. Wolf
The LancetRhythm or rate control in atrial fibrillation—Pharmacological Intervention in Atrial Fibrillation (PIAF): a randomised trial
1,136 Citations2000Stefan H. Hohnloser, Karl‐Heinz Kück +1 more
With respect to symptomatic improvement in patients with atrial fibrillation, the therapeutic strategies of rate versus rhythm control yielded similar clinical results overall, however, exercise tolerance is better with rhythm control, although hospital admission is more frequent.
CirculationPulmonary Vein Isolation for Paroxysmal and Persistent Atrial Fibrillation
1,122 Citations2002Hakan Oral, Bradley P. Knight +10 more
The clinical efficacy of pulmonary vein isolation is much lower when AF is persistent than when it is paroxysmal, and with a segmental isolation approach that targets at least 3 PVs, a clinically satisfactory result can be achieved in >80% of patients with paroxYSmal AF.
The American Journal of CardiologyPrevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study)
1,112 Citations1994Curt D. Furberg, Bruce M. Psaty +4 more
The low prevalence of AF in the absence of clinical and subclinical cardiovascular disease calls into question the existence and clinical usefulness of the concept of so-called "lone atrial fibrillation" in the elderly.
Journal of the American College of CardiologyAtrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a retrospective analysis of the SOLVD trials
975 Citations1998DanielL Dries, D. Exner +4 more
The presence of atrial fibrillation in patients with asymptomatic and symptomatic left ventricular systolic dysfunction is associated with an increased risk for all-cause mortality, largely explained by an increase risk for pump-failure death.
BMJSix minute walking test for assessing exercise capacity in chronic heart failure.
563 Citations1986D P Lipkin, A. Scriven +2 more
The six minute test is a simple objective guide to disability in patients with chronic heart failure and could be of particular value in assessing patients with severe heart failure but less useful in assessing patients with mild heart failure.
CirculationClinical Outcomes After Ablation and Pacing Therapy for Atrial Fibrillation
472 Citations2000Mark A. Wood, Chris Brown-Mahoney +2 more
Ablation and pacing therapy improves a broad range of clinical outcomes for patients with medically refractory atrial fibrillation and the calculated 1-year mortality rates after this therapy are low and comparable with medical therapy.
The LancetRISK OF STROKE IN NON-RHEUMATIC ATRIAL FIBRILLATION
441 Citations1987K. M. Flegel, M. J. Shipley +1 more
The absolute rates of stroke in both cohorts were lower than those reported in the Framingham study, implying a lesser potential benefit from preventive measures, and lower rates should be considered in the planning of trials.
CHEST JournalAntithrombotic Therapy in Atrial Fibrillation
361 Citations2001Gregory W. Albers, James E. Dalen +4 more
Abbreviations: ACUTE 5 Assessment of Cardioversion Using Transesophageal Echocardiography; SPAF 5 Stroke Prevention in Atrial Fibrillation; SPINAF 5 Stroke Prevention in Nonrheumatic Atrial Fibrillation.
StrokeAdverse Outcomes and Predictors of Underuse of Antithrombotic Therapy in Medicare Beneficiaries With Chronic Atrial Fibrillation
303 Citations2000Brian F. Gage, Michael Boechler +5 more
The underuse of antithrombotic therapy in Medicare beneficiaries who have NVAF is associated with measurable adverse outcomes, and the benefit of warfarin therapy may extend to frail, elderly patients, a group that was excluded from randomized controlled trials.
The American Journal of CardiologySerial antiarrhythmic drug treatment to maintain sinus rhythm after electrical cardioversion for chronic atrial fibrillation or atrial flutter
279 Citations1991Harry J. Crijns, Isabelle C. Van Gelder +4 more
It is concluded that serial treatment may improve arrhythmia prognosis in atrial fibrillation or flutter, with an acceptable incidence of proarrhythmic events.
Annals of Internal MedicineAtrial Fibrillation and Thromboembolism: A Decade of Progress in Stroke Prevention
267 Citations1999Robert G. Hart, Jonathan L. Halperin
Adjusted-dose warfarin has the remarkable potential to reverse almost entirely the increased risk for cardioembolic stroke that accompanies atrial fibrillation and was not substantially offset by major hemorrhage in the randomized trials.
Annals of Internal MedicineTrends in the Incidence and Survival of Patients with Hospitalized Myocardial Infarction, Olmsted County, Minnesota, 1979 to 1994
246 Citations2002Véronique L. Roger, Steven J. Jacobsen +7 more
Examination of trends in incidence and survival of patients with hospitalized myocardial infarction in Olmsted County, Minnesota suggested that the burden of coronary deaths has been shifted toward women and elderly persons, suggesting the importance of monitoring coronary disease trends in this group.
Archives of Internal MedicineChronic atrial fibrillation. Success of serial cardioversion therapy and safety of oral anticoagulation
242 Citations1996Isabelle C. Van Gelder
Many patients with chronic atrial fibrillation failed to respond to the serial electrical cardioversion strategy, but in younger patients with a fair exercise tolerance and a duration of atrialfibrillation shorter than 36 months, this approach may be worthwhile.
Journal of the American College of CardiologyCardiac arrhythmias on 24-h ambulatory electrocardiography in older women and men: The cardiovascular health study
179 Citations1994Teri A. Manolio, Curt D. Furberg +6 more
Arrhythmias are common in the elderly, and their association with cardiovascular disease differs by gender, and Ventricular arrhythmias were associated with a higher prevalence of cardiovascular disease and its risk factors and with subclinical disease, as measured by increasedleft ventricular mass and impaired left ventricular function.
American Heart JournalBaseline characteristics of patients with atrial fibrillation: The AFFIRM Study
174 Citations2002
The patients in the AFFIRM Study were representative of patients at high risk for complications from atrial fibrillation, which indicates that the results of this large clinical trial will be relevant to patient care.
The American Journal of CardiologyAmiodarone for maintenance of sinus rhythm after conversion of atrial fibrillation in the setting of a dilated left atrium
152 Citations1987Michael A. Brodsky, Byron J. Allen +4 more
Patients with LA dimensions between 46 and 60 mm who are significantly compromised by AF can often be maintained in sinus rhythm with amiodarone therapy, however, in patients with larger LA dimensions AF is likely to return despite aggressive antiarrhythmic therapy with amodarone, a drug with potentially serious side effects.
BMJSystematic review of long term anticoagulation or antiplatelet treatment in patients with non-rheumatic atrial fibrillation
127 Citations2001Fiona Taylor, H Cohen +1 more
The heterogeneity between the trials and the limited data result in considerable uncertainty about the value of long term anticoagulation compared with antiplatelet treatment, and the risks of bleeding and the higher cost of antICOagulation make it an even less convincing treatment option.
Journal of the American College of CardiologyAtrial fibrillation: Current understandings and research imperatives
127 Citations1993
The epidemiology of atrial fibrillation is discussed and of the etiology, mechanism, management and future research directions in the study of this arrhythmia are discussed.
HeartMeta-analysis of randomised controlled trials of the effectiveness of antiarrhythmic agents at promoting sinus rhythm in patients with atrial fibrillation
125 Citations2002Graham Nichol, F McAlister +6 more
A meta-analysis of randomised controlled trials to estimate the effectiveness of antiarrhythmic drugs at promoting sinus rhythm in patients with atrial fibrillation found that class IA, IC, and III drugs are associated with increased sinu rhythm at follow up compared with placebo.
PubMedEfficacy of agents for pharmacologic conversion of atrial fibrillation and subsequent maintenance of sinus rhythm: a meta-analysis of clinical trials.
91 Citations2000Marlene R. Miller, R L McNamara +6 more
Although multiple antiarrhythmic agents had strong evidence of efficacy compared with control treatment for MSR, ibutilide/dofetilide and flecainide had particularly strong evidence on direct agent comparisons and adverse event rates.
CirculationNonpharmacological Approaches to Atrial Fibrillation
69 Citations2001Melvin M. Scheinman, Fred Morady
The current status of various nonpharmacological options for the treatment of atrial fibrillation is reviewed.
Journal of Interventional Cardiac ElectrophysiologyAtrial Fibrillation: A Risk Factor for Increased Mortality – An AVID Registry Analysis
64 Citations2001D. George Wyse, J. Christopher Love +10 more
Atrial fibrillation/flutter is a significant independent risk factor for increased mortality in patients presenting with ventricular tachyarrhythmias and this risk may have been overestimated in previous studies that could not adjust for the proarrhythmic effects of antiarrHythmic drugs other than amiodarone or sotalol.
International Journal of CardiologyTrends in case-fatality in 22 968 patients admitted for the first time with atrial fibrillation in Scotland, 1986–1995
39 Citations2002Simon Stewart, Kate Macintyre +7 more
The number of first-ever hospitalisations for AF has increased twofold during the 10-year period 1986-1995 and the age of patients has progressively increased during this period, short and medium case-fatality rates have declined, especially in men.
Journal of Cardiovascular ElectrophysiologyFrequency of Symptomatic Atrial Fibrillation in Patients Enrolled in the Atrial Fibrillation Follow‐up Investigation of Rhythm Management (AFFIRM) Study
15 Citations2002Andrew E. Epstein, Humberto Vidaillet +5 more
The frequency of symptomatic paroxysmal atrial fibrillation may identify subsets with different characteristics, which has important therapeutic implications if the frequency identifies subset with distinguishing features.