Table 4 Rate versus rhythm control meta-analyses summary
Caldeira et al,5 20128 RCTs (PIAF,9 RACE,10 AFFIRM,11 STAF,12 HOT CAFE,13 AF-CHF,14 J-RHYTHM,15 CAFE-II16)N = 7499 participants with AF, mean age 68 y, mostly men (63.4%-82%); HTN (42.8%-64.3%), valvular disease (4.9%-17%), CAD (7.4%-43.5%), HF (3.6%-70%); mean follow-up 2.9 y (range 1-3.5 y)No significant difference between rate and rhythm control in all-cause mortality, CV mortality, arrhythmia or sudden death, ischemic stroke or embolic events, or serious bleeding; there were significantly fewer systemic embolic events in the rate-control group in trials where more than 50% of patients reported HF (RR= 0.43, 95% CI 0.21-0.89)
Cordina and Mead,6 20052 RCTs (PIAF,9 AFFIRM11)N = 4312 participants > 18 y with acute, paroxysmal, or sustained AF or atrial flutter, of any duration and any cause (most patients were > 60 y with considerable CV risk factors)No difference in mortality or quality of life between rate- or rhythm-control strategies; hospitalization (P <.001) and adverse events (P <.05) were significantly higher in the rhythm-control group
De Denus et al,7 20055 RCTs (PIAF,9 RACE,10 AFFIRM,11 STAF,12 HOT CAFE13)N = 5239 participants with first or recurrent AF, mean age 65.1 y, mostly men (65.3%); CAD (29.9%), HTN (52.7%); mean duration of follow-up 1.9 yRate control was significantly better for the combined end point of all-cause death and thromboembolic stroke (NNT = 50); however, for single end points of death and stroke individually, the difference between rate and rhythm strategies was non-significant; differences in serious bleeding (intracranial and extracranial) and systemic embolism were also not significant
Kumana et al,8 20055 RCTs (PIAF,9 RACE,10 AFFIRM,11 STAF,12 HOT CAFE13)N = 5239 participants with persistent or recurrent AFRate control was significantly better (P <.01) than rhythm control for preventing hospitalizations (NNH = 35 for rhythm control); differences in death, non-CNS bleeding, and ischemic stroke were non-significant
  • AF–atrial fibrillation, CAD–coronary artery disease, CNS–central nervous system, CV–cardiovascular, HF–heart failure, HTN–hypertension, NNH–number needed to harm, NNT–number needed to treat, RCT–randomized controlled trial, RR–relative risk.