Rhythm Control Versus Rate Control and Clinical Outcomes in Patients With Atrial Fibrillation: Results From the ORBIT-AF Registry.

JACC. Clinical Electrophysiology
Amit NoheriaORBIT-AF Investigators and Patients

Abstract

The study sought to evaluate clinical outcomes in clinical practice with rhythm control versus rate control strategy for management of atrial fibrillation (AF). Randomized trials have not demonstrated significant differences in stroke, heart failure, or mortality between rhythm and rate control strategies. The comparative outcomes in contemporary clinical practice are not well described. Patients managed with a rhythm control strategy targeting maintenance of sinus rhythm were retrospectively compared with a strategy of rate control alone in a AF registry across various U.S. practice settings. Unadjusted and adjusted (inverse-propensity weighted) outcomes were estimated. The overall study population (N = 6,988) had a median of 74 (65 to 81) years of age, 56% were males, 77% had first detected or paroxysmal AF, and 68% had CHADS2 score ≥2. In unadjusted analyses, rhythm control was associated with lower all-cause death, cardiovascular death, first stroke/non-central nervous system systemic embolization/transient ischemic attack, or first major bleeding event (all p < 0.05); no difference in new onset heart failure (p = 0.28); and more frequent cardiovascular hospitalizations (p = 0.0006). There was no difference in the incidence...Continue Reading

References

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Citations

Nov 15, 2018·Journal of Cardiovascular Electrophysiology·Sara N Koenig, Peter J Mohler
Apr 15, 2020·European Heart Journal. Cardiovascular Pharmacotherapy·Felix HoferPatrick Sulzgruber
Mar 28, 2020·Pulmonary Circulation·Cyrus A VahdatpourHarold I Palevsky
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Aug 11, 2021·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·José Miguel Rivera-CaravacaFrancisco Marín
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