PURPOSE: Rate- and rhythm control are two fundamental strategies to treat atrial fibrillation (AF). However, there are inconsistent results between clinical trials about which treatment should be preferred. The aims of this study were to systematically summarize the clinical trials and compare rate- and rhythm control strategies regarding composite outcome of all cause mortality, worsening heart failure, and thromboembolic and bleeding events. METHODS: English and non-English studies that were published from 1966 onwards were included in this meta-analysis if they were prospective randomized controlled trials which compared rate- and rhythm control strategies in patients with AF. The individual and combined outcomes were analyzed quantitatively with odds ratio and 95 % confidence interval. RESULTS: Ten prospective randomized controlled trials with 7,876 patients were identified. There was no significant difference regarding primary composite outcome (11.47 vs. 11.03 % per year; odds ratio (OR), 1.03; 95 % confidence interval (CI), 0.90-1.20; P = 0.64) between rate- and rhythm control groups in overall age group. Meta-analysis for studies with mean age <65 years showed that rate control had significantly higher risk in primary composite outcome compared with rhythm control (8.74 vs. 4.80 % per year; OR, 1.89; 95 %CI, 1.26-2.86; P = 0.002). CONCLUSIONS: A significant trend towards that rhythm control may be a preferable strategy for younger AF patients was observed in this study.