EBQ:AFFIRM

incomplete Journal Club Article

Wyse DG, et al. "A Comparison of Rate Control and Rhythm Control in Patients with Atrial Fibrillation". NEJM. 2002. 347(23):1825-1833.
PubMed Full text PDF

Clinical Question

Which is better for treating atrial fibrillation, rate control allowing Afib at a lower heart rate, or rhythm control by maintaining sinus rhythm?

Conclusion

Rhythm control for Afib offers no survival advantage over rate control, and rate control is potentially advantageous given the lower risk of adverse drug reactions with rhythm control medications.

Study Design

• Multicenter, randomized controlled trial

Population

N= 4060 (7401 patients eligible and offered enrollment)

• Rate control group N=2027
• Rhythm control group N=2033

Patient Demographics

• Mean age: 69.7
• Women: 39.3%
• Ethnic minority: 11.3%
• Predominant cardiac diagnosis:
  • CAD: 26.1%
  • Cardiomyopathy: 4.1%
  • HTN: 50.8%
  • Valvular disease: 4.9%
  • Other: 1.0%
  • None: 12.4%
• Duration of qualifying Afib >2days: 69.2%
• First episode of Afib: 35.5%

Inclusion Criteria

• Age 65 or older or risk factors for stroke or death
• Diagnosis of atrial fibrillation that was:
  • recurrent
  • likely to cause illness or death
  • likely to require extended treatment

Exclusion Criteria

• Contraindication to anticoagulation
• Unable to take at least 2 drugs in each treatment group
• Unable to immediately start therapy after randomization