Rate And Rhythm Control Strategy In Patients With Nonvalvular Atrial Fibrillation

Objective: Rate and rhythm control are two fundamental strategies to treat atrial fibrillation. We conducted a meta-analysis to explore which strategy is superior to another.Method: We used MEDLINE, The Cochrane Library, The Clinical Trials, The Chinese VIP Database and manual search up to May 2010 for eligible trials, and 10 prospective randomized control trials (RCTs) with total populations of 7876 were included for final meta-analysis.Result: Rhythm control had significantly more benefits regarding all cause mortality (3.6% vs. 1.9%; OR: 1.89; 95%CI: 1.01-3.53) and worsening heart failure (2.3% vs. 0.3%; OR: 5.6; 95%CI: 1.44-21.69) in subgroup age<65. For whole age group, hospitalization in rate control was significantly lower than in rhythm control (17.56% vs. 22.98%; OR: 0.37; 95%CI: 0.19-0.71), and there were no significant difference regarding all cause mortality (5.3% vs. 5.0%; OR: 1.03; 95%CI: 0.84-1.26), thromboembolic events (1.49% vs. 1.46%; OR: 1.02; 95%CI: 0.71-1.48), bleeding events (1.78% vs. 1.73%; OR: 1.02; 95%Cl: 0.70-1.49) and worsening heart failure (3.81% vs. 3.61%; OR: 1.04; 95%CI: 0.80-1.36) between rate and rhythm control.Conclusion: rhythm control strategy might be the first consideration when we treat younger nonvalvular AF patient.