Steven A. Rothman, MD - AFib Treatment: General Population - Figure 12

Stroke Risk in AF

A number of well-known studies have looked at rhythm versus rate control and their outcomes.[59] [60] [61] [62] Two of the larger of these studies included

RACE,[59] which enrolled 500 patients with recurrent persistent AFib and randomized them to treatment aimed at rate control (oral anticoagulants and rate-slowing medication) or rhythm control (serial cardioversions, antiarrhythmic drugs, and oral anticoagulants).
AFFIRM,[60] the largest AFib therapy trial, which enrolled 4000 patients with chronic and paroxysmal AFib and randomized them to either a rhythm or rate control strategy.

Two further trials included STAF and PAIF. In these trials the patients were generally >65 years of age or had other risk factors for stroke.

Rothman SA. Am J Med 2013; 126: 00-00.

[AFFIRM = Atrial Fibrillation Follow-up Investigation of Rhythm Management; PIAF = Pharmacological Intervention in Atrial Fibrillation; RACE= Rate Control versus Electrical Cardioversion for Persistent Atrial Fibrillation; STAF = Strategies of Treatment of Atrial Fibrillation]

Complete references for all slides

References

[59] Van Gelder IC, Hagens VE, Bosker HA, et al; Rate Control versus Electrical Cardioversion for Persistent Atrial Fibrillation Study Group. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med. 2002;347:1834-1840.

[60] Wyse DG, Waldo AL, DiMarco JP, et al; Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002;347:1825-1833.

[61] Carlsson J, Miketic S, Windeler J, et al; STAF Investigators. Randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation: the Strategies of Treatment of Atrial Fibrillation (STAF) study. J Am Coll Cardiol. 2003;4:1690-1696.

[62] Grönefeld G, Hohnloser SH. Towards a consensus in rate versus rhythm control for management of atrial fibrillation: insights from the PIAF trial. Card Electrophysiol Rev. 2003;7:113-117.