NEW YORK -- June 20, 2008 -- Rate-control strategy should be considered the primary approach for the management of atrial fibrillation in patients with congestive heart failure, when compared with rhythm-control, according to findings presented by the Montreal Heart Institute. The results were reported in the June 19 issue of the New England Journal of Medicine.
The Atrial Fibrillation and Congestive Heart Failure Trial (AF-CHF) was a prospective, multicentre study aimed to improve treatment, with the objective of reducing mortality and morbidity linked with atrial fibrillation and heart failure.
The study was directed by Denis Roy, MD, Montreal Heart Institute; Department of Medicine, Université de Montréal, Montreal, Quebec, in collaboration with Mario Talajic, MD, Montreal Heart Institute, Montreal, with contributions from several Canadian researchers and international experts.
The study included a total of 1,376 patients, enrolled between May 2001 and June 2005, who were randomised to a rhythm-control (n = 682) or rate-control (n = 694) strategy. The primary endpoint was cardiovascular mortality.
The intention-to-treat analysis revealed no difference in the primary endpoint between the 2 groups. Cardiovascular death occurred in 182 (27%) patients in the rhythm-control group compared with 175 (25%) in the rate-control arm. Total mortality, worsening heart failure, and stroke were similar between the 2 groups.
The rate-control strategy eliminated the need for repeated cardioversions and reduced rates of hospitalisation compared with the rhythm-control group in which hospitalisations were more frequent -- many for management of atrial fibrillation.
"It is now clear that the rate-control strategy offers a less complex approach for the management of atrial fibrillation and could reduce rates of hospitalisation" said Dr. Roy.
"The result of this provocative study challenges the conventional wisdom, and shows that these patients can be conservatively managed, without repeated electric shocks. This will serve as a new goal post for future care of these patients," said Peter Liu, MD, Canadian Institutes of Health Research, Institute of Circulatory and Respiratory Health, Toronto, Ontario.
SOURCE: The Montreal Health Institute
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