Yonsei Med J.  2018 Mar;59(2):258-264. 10.3349/ymj.2018.59.2.258.

Comparison of Rhythm and Rate Control Strategies for Stroke Occurrence in a Prospective Cohort of Atrial Fibrillation Patients

• Choi YJ
• Kang KW
• Kim TH
• Cha MJ
• Lee JM
• Park J
• Park JK
• Shim J
• Uhm JS
• Kim J
• Park HW
• Choi EK
• Kim JB
• Kim C
• Lee YS
• Joung B

• KMID: 2418789
• DOI: http://doi.org/10.3349/ymj.2018.59.2.258

Abstract

PURPOSE
Comparisons of rhythm and rate control strategies for stroke prevention in patients with atrial fibrillation (AF) are still inconclusive. We compared differences in clinical outcomes between the rhythm and rate control strategies.
MATERIALS AND METHODS
The COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) registry prospectively enrolled 6000 patients who were treated for AF using real-world guideline adherence at multiple referral centers. In total, 2508 (41.8%) patients were clinically followed up for over six months. Of these, 1134 (45.2 %) patients treated by rhythm control and 1374 (54.8 %) patients treated by rate control were analyzed for clinical outcomes, including stroke and cardiovascular outcomes.
RESULTS
Among all patients (age, 68±10 years; male, 62.4%), those treated with the rhythm control strategy were significantly younger, had more symptomatic paroxysmal AF, and a shorter AF duration, and were less likely to have diabetes, renal dysfunction, and heart failure, compared to those treated with the rate control strategy (CHAâ‚‚DSâ‚‚-VASc score 2.4±1.5 vs. 3.1±1.7, p < 0.001). Even though oral anticoagulation was similarly prescribed in both groups, occurrence of stroke was less likely to occur in the rhythm control strategy group (0.0% vs. 0.7%, p=0.015). Multivariate Cox hazard regression showed that only age, especially more than 75 years old, were significantly correlated with the occurrence of stroke, regardless of the strategy used for treatment.
CONCLUSION
In this prospective AF cohort, compared with the rate control strategy, the rhythm control strategy was associated with fewer cardiovascular events and strokes in a short-term period.

Keyword

Atrial fibrillation; rhythm control; rate control; stroke

MeSH Terms

Administration, Oral
Aged
Antithrombins/administration & dosage/therapeutic use
Atrial Fibrillation/drug therapy/*physiopathology
Female
Heart Rate/*physiology
Humans
Kaplan-Meier Estimate
Male
Proportional Hazards Models
Prospective Studies
Stroke/drug therapy/*etiology/*physiopathology
Treatment Outcome
Antithrombins

Figure

• 

  Fig. 1 Kaplan-Meier survival curve showing the comparison of the rhythm and rate control strategies for stroke occurrence.

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