#36 In atrial fibrillation: rate versus rhythm and how slow do you go?
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- Statistically significantly fewer hospitalizations:1 50.8% versus 58.3%, Number Needed to Treat (NNT)=14.
- No difference in individual composite of embolic events, or individual outcomes of death, stroke or systemic embolism, worsening heart failure, or bleeding.1,2
- Similar quality of life.2
- Less likely to be in sinus rhythm (example from largest RCT:3 35% versus 63%).
- Composite outcome of cardiovascular, bleed, and hospitalization (12.9% versus 14.9% [hazard ratio 0.84 (90% CI 0.58 to 1.21)].
- Although historically it was thought attempting to restore sinus rhythm was advantageous, medications used to establish and maintain sinus rhythm have several risks.
- Even in patients with coexistent congestive heart failure and AFib, mortality and morbidity outcomes did not differ between rate and rhythm groups.5
- Canadian guidelines recommend:6
- Rate control for most patients;
- Select patients may benefit from rhythm control, e.g. highly symptomatic, quality of life impairment, multiple recurrences, arrhythmia-induced cardiomyopathy.
- Regardless of treatment strategy, antithrombotic therapy is central to AFib management.6