Lenient versus strict rate control in patients with atrial fibrillation

January 01, 0001

Lenient versus strict rate control in patients with atrial fibrillation

These Dutch investigators randomly assigned 614 patients with permanent atrial fibrillation to undergo a lenient rate-control strategy (resting heart rate less than 110 beats per minute) or a strict rate-control strategy (resting heart rate less than 80 beats per minute and heart rate during moderate exercise <110 beats per minute). The primary outcome was a composite of death from cardiovascular causes, hospitalization for heart failure, and stroke, systemic embolism, bleeding, and life-threatening arrhythmic events. The duration of follow-up was at least 2 years, with a maximum of 3 years.

They found: "The estimated cumulative incidence of the primary outcome at 3 years was 12.9% in the lenient-control group and 14.9% in the strict-control group, with an absolute difference with respect to the lenient- control group of -2.0 percentage points. The frequencies of the components of the primary outcome were similar in the two groups. More patients in the lenient-control group met the heart-rate target or targets (304 {97.7%}, vs. 203 {67.0%} in the strict-control group) with fewer total visits (75 vs. 684). The frequencies of symptoms and adverse events were similar in the two groups."

The authors concluded: "In patients with permanent atrial fibrillation, lenient rate control is as effective as strict rate control and is easier to achieve."

So the goal for rate control in patients with chronic atrial fibrillation is less than 110 bpm.

For the full abstract, click here.

N Engl J Med 362(15):1363-1373, 15 April 2010
© 2010 to the Massachusetts Medical Society
Lenient versus Strict Rate Control in Patients with Atrial Fibrillation. Isabelle C. Van Gelder, Hessel F. Groenveld, Harry J.G.M. Crijns, et al. Correspondence to Dr. van Gelder: i.c.van.gelder@thorax.umcg.nl

Category: K. Circulatory. Keywords: fibrillation, rate control, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 4 May 2010 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.