Korean J Intern Med.  2021 Jan;36(1):114-123. 10.3904/kjim.2019.063.

Comparative occurrence of ischemic stroke with the rhythm versus rate control strategy in a national prospective cohort of atrial fibrillation

Affiliations
  • 1Department of Neurology, Eulji University Hospital, Daejeon, Korea
  • 2Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
  • 3Division of Cardiology, Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea
  • 4Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
  • 5Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea
  • 6Department of Cardiology, Ewha Womans University School of Medicine, Seoul, Korea
  • 7Department of Cardiology, Hanyang University Seoul Hospital, Seoul, Korea
  • 8Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 9Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
  • 10Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 11Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
  • 12Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea

Abstract

Background/Aims
Comparative occurrence of ischemic stroke for rhythm versus rate control strategy in patients with non-valvular atrial fibrillation (NVAF) is still inconclusive. The purpose of this study was to investigate whether the rhythm control strategy is associated with a lower risk of ischemic stroke compared to the rate control strategy in NVAF patients.
Methods
The CODE-AF registry prospectively enrolled 6,280 consecutive patients who were treated for NVAF at 10 tertiary referral centers in South Korea. Of these, 2,513 NVAF patients (age, 67 ± 10 years; male, 61.8%) were clinically followed up for over 1-year and divided into rate and rhythm control groups.
Results
Those treated with the rhythm control strategy were younger and had less proportions of underlying disease compared to those treated with the rate control strategy. After the propensity matching analysis, those treated with the rhythm control strategy had similar baseline characteristics including the CHA 2 DS 2 -VASC score compared to those treated with the rate control strategy. The rate of oral anticoagulation, all bleeding, and hospitalization were also similarly between the two groups. The incidence rate of ischemic stroke in the rhythm control group was significantly lower than in the rate control group (0.7 vs. 6.9 per 1,000 person-years, p = 0.011).
Conclusions
The rhythm control strategy demonstrated a beneficial effect to lower the risk of ischemic stroke during a 1-year follow-up compared to the rate control strategy.

Keyword

Atrial fibrillation; Rhythm; Rate; Stroke
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