Skip to main content
Journal cover image

Is rhythm-control superior to rate-control in patients with atrial fibrillation and diastolic heart failure?

Publication ,  Journal Article
Kong, MH; Shaw, LK; O'Connor, C; Califf, RM; Blazing, MA; Al-Khatib, SM
Published in: Ann Noninvasive Electrocardiol
July 2010

BACKGROUND: Although no clinical trial data exist on the optimal management of atrial fibrillation (AF) in patients with diastolic heart failure, it has been hypothesized that rhythm-control is more advantageous than rate-control due to the dependence of these patients' left ventricular filling on atrial contraction. We aimed to determine whether patients with AF and heart failure with preserved ejection fraction (EF) survive longer with rhythm versus rate-control strategy. METHODS: The Duke Cardiovascular Disease Database was queried to identify patients with EF > 50%, heart failure symptoms and AF between January 1,1995 and June 30, 2005. We compared baseline characteristics and survival of patients managed with rate- versus rhythm-control strategies. Using a 60-day landmark view, Kaplan-Meier curves were generated and results were adjusted for baseline differences using Cox proportional hazards modeling. RESULTS: Three hundred eighty-two patients met the inclusion criteria (285 treated with rate-control and 97 treated with rhythm-control). The 1-, 3-, and 5-year survival rates were 93.2%, 69.3%, and 56.8%, respectively in rate-controlled patients and 94.8%, 78.0%, and 59.9%, respectively in rhythm-controlled patients (P > 0.10). After adjustments for baseline differences, no significant difference in mortality was detected (hazard ratio for rhythm-control vs rate-control = 0.696, 95% CI 0.453-1.07, P = 0.098). CONCLUSIONS: Based on our observational data, rhythm-control seems to offer no survival advantage over rate-control in patients with heart failure and preserved EF. Randomized clinical trials are needed to verify these findings and examine the effect of each strategy on stroke risk, heart failure decompensation, and quality of life.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Ann Noninvasive Electrocardiol

DOI

EISSN

1542-474X

Publication Date

July 2010

Volume

15

Issue

3

Start / End Page

209 / 217

Location

United States

Related Subject Headings

  • Warfarin
  • Proportional Hazards Models
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Humans
  • Heart Rate
  • Heart Failure, Diastolic
  • Female
  • Diuretics
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Kong, M. H., Shaw, L. K., O’Connor, C., Califf, R. M., Blazing, M. A., & Al-Khatib, S. M. (2010). Is rhythm-control superior to rate-control in patients with atrial fibrillation and diastolic heart failure? Ann Noninvasive Electrocardiol, 15(3), 209–217. https://doi.org/10.1111/j.1542-474X.2010.00365.x
Kong, Melissa H., Linda K. Shaw, Christopher O’Connor, Robert M. Califf, Michael A. Blazing, and Sana M. Al-Khatib. “Is rhythm-control superior to rate-control in patients with atrial fibrillation and diastolic heart failure?Ann Noninvasive Electrocardiol 15, no. 3 (July 2010): 209–17. https://doi.org/10.1111/j.1542-474X.2010.00365.x.
Kong MH, Shaw LK, O’Connor C, Califf RM, Blazing MA, Al-Khatib SM. Is rhythm-control superior to rate-control in patients with atrial fibrillation and diastolic heart failure? Ann Noninvasive Electrocardiol. 2010 Jul;15(3):209–17.
Kong, Melissa H., et al. “Is rhythm-control superior to rate-control in patients with atrial fibrillation and diastolic heart failure?Ann Noninvasive Electrocardiol, vol. 15, no. 3, July 2010, pp. 209–17. Pubmed, doi:10.1111/j.1542-474X.2010.00365.x.
Kong MH, Shaw LK, O’Connor C, Califf RM, Blazing MA, Al-Khatib SM. Is rhythm-control superior to rate-control in patients with atrial fibrillation and diastolic heart failure? Ann Noninvasive Electrocardiol. 2010 Jul;15(3):209–217.
Journal cover image

Published In

Ann Noninvasive Electrocardiol

DOI

EISSN

1542-474X

Publication Date

July 2010

Volume

15

Issue

3

Start / End Page

209 / 217

Location

United States

Related Subject Headings

  • Warfarin
  • Proportional Hazards Models
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Humans
  • Heart Rate
  • Heart Failure, Diastolic
  • Female
  • Diuretics