Sinus Rhythm Maintenance May Be Ineffective Strategy

Strategy not associated with better outcomes in patients with atrial fibrillation and heart failure

TUESDAY, April 20 (HealthDay News) -- In patients with atrial fibrillation and congestive heart failure, a rhythm-control strategy or the presence of sinus rhythm is not associated with improved outcomes, according to a study published in the April 27 issue of the Journal of the American College of Cardiology.

Mario Talajic, M.D., of the Montreal Heart Institute and Université de Montréal, and colleagues studied 1,376 patients with atrial fibrillation, ejection fraction of 35 percent or less, and heart failure symptoms who were randomly assigned to either a rhythm-control or rate-control strategy. During the study, 445 (32 percent) of the patients died and 402 (29 percent) had worsening heart failure.

The researchers found that the rhythm-control strategy was not predictive of cardiovascular mortality, all-cause mortality, or worsening heart failure. In analyses devised to isolate the effect of underlying rhythm, they also found that sinus rhythm was not associated with cardiovascular mortality, total mortality, or worsening heart failure.

"Clinical implications are substantial, consistent with all previous clinical trials comparing rate- versus rhythm-control strategies and support the notion that rate control is an acceptable primary treatment option in a sizable proportion of the population with atrial fibrillation with symptomatic heart failure and irreversible left ventricular systolic dysfunction," the authors conclude.

Several study authors disclosed financial ties to pharmaceutical and medical device companies.

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