- Question
- In high-risk patients with atrial fibrillation, is attempting to maintain sinus rhythm with cardioversion and antiarrhythmic drugs better for survival than rate control alone?
- Design
- Randomized, multicenter trial comparing two treatment strategies in 4060 patients with atrial fibrillation.
- Population
- Patients with atrial fibrillation and a high risk of stroke or death, with a mean age of 69.7 years; 70.8% had a history of hypertension and 38.2% had coronary artery disease.
- Intervention
- Rhythm-control strategy: cardioversion and antiarrhythmic drug therapy to maintain sinus rhythm.
- Control
- Rate-control strategy: rate-controlling drugs, allowing atrial fibrillation to persist.
- Primary outcome
- Overall mortality.
- Results
- There were 356 deaths in the rhythm-control group and 310 in the rate-control group (five-year mortality 23.8% and 21.3%, respectively; HR 1.15; 95% CI 0.99 to 1.34; P=0.08). More patients were hospitalized in the rhythm-control group.
- Safety
- Adverse drug effects were more frequent in the rhythm-control group. In both groups, most strokes occurred after warfarin had been stopped or with a subtherapeutic INR.
- Conclusion
- Rhythm control offers no survival advantage over rate control, which also has potential advantages such as fewer adverse drug effects.
- Why it matters
- It showed that maintaining sinus rhythm with antiarrhythmic drugs does not improve survival, making rate control an acceptable alternative in this type of patient, with continued anticoagulation where indicated.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 7, 2026