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Conventional treatment of atrial fibrillation (AF)--a common disorder in which the heart beats rapidly and irregularly--involves restoring normal heart rhythm and controlling the heart rate to prevent stroke, heart failure, and death. New research suggests, however, that controlling the heart rate alone may be a safe and effective strategy for some patients.
"The study was presented at the American College of Cardiology meeting in March," explains Heart Watch Editor Dr. Douglas Zipes. "The trial was designed to test whether it was better to maintain sinus rhythm or to control the ventricular rate. Data showed that there was no difference in efficacy."
"This is very important," he continues, "because it now allows the physician to avoid potentially toxic drugs in an attempt to maintain sinus rhythm."
The AFFIRM (Atrial Fibrillation Follow-up Investigation in Rhythm Management) trial of "rhythm" versus "rate" control included 4,060 patients in Canada and the United States. Study participants were over 65 years old or under 65 and at high risk for stroke.
"Even if physicians start with rhythm control, they should be fairly quick to move on to rate control if the initial approach does not work," said D. George Wyse, M.D., Ph.D., of the Cardiac Arrhythmia Clinic at the University of Calgary in Alberta, Canada. "We can say that [rate control] is at least as good as rhythm control and should be considered a primary strategy."
Researchers conclude that a treatment regimen of rate control and blood thinners appears preferable for persons similar to those studied in the AFFIRM trial. The recommendation does not apply to most younger persons or to those with troublesome symptoms from AF despite good rate control.
Heart palpitations, lack of energy, dizziness, and chest discomfort are all symptoms of atrial fibrillation, a condition affecting more than 2.2 million people in the United States.
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