Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Arrhythmia/Electrophysiology
Optimal Treatment Strategy for Patients With Paroxysmal Atrial Fibrillation
J-RHYTHM Study
Satoshi OgawaTakeshi YamashitaTsutomu YamazakiYoshifusa AizawaHirotsugu AtarashiHiroshi InoueTohru OheHiroshi OhtsuKen OkumuraTakao KatohShiro KamakuraKoichiro KumagaiYoshihisa KurachiItsuo KodamaYukihiro KoretsuneTetsunori SaikawaMasayuki SakuraiKaoru SugiToshifumi TabuchiHaruaki NakayaToshio NakayamaMakoto HiraiMasahiko FukataniHideo Mitamurafor the J-RHYTHM Investigators
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2009 Volume 73 Issue 2 Pages 242-248

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Abstract

Background Although previous clinical trials demonstrated the non-inferiority of a rate control to rhythm control strategy for management of atrial fibrillation (AF), the optimal treatment strategy for paroxysmal AF (PAF) remains unclear. Methods and Results A randomized, multicenter comparison of rate control vs rhythm control in Japanese patients with PAF (the Japanese Rhythm Management Trial for Atrial Fibrillation (J-RHYTHM) study) was conducted. The primary endpoint was a composite of total mortality, symptomatic cerebral infarction, systemic embolism, major bleeding, hospitalization for heart failure, or physical/psychological disability requiring alteration of treatment strategy. In the study, 823 patients with PAF were followed for a mean period of 578 days. The primary endpoint occurred in 64 patients (15.3%) assigned to rhythm control and in 89 patients (22.0%) to rate control (P=0.0128). No significant differences between the treatment strategies were observed in the incidences of death, stroke, bleeding and heart failure. Meanwhile, significantly fewer patients requested changes of assigned treatment strategy in the rhythm control vs the rate control group, which was accompanied by improvement in AF-specific quality of life scores. Conclusion The J-RHYTHM study showed that rhythm control was associated with fewer primary endpoints than rate control. However, mortality and cardiovascular morbidity were not affected by the treatment strategy (umin-CTR No. C000000106). (Circ J 2009; 73: 242 - 248)

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© 2009 THE JAPANESE CIRCULATION SOCIETY
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