As debate over rhythm control vs. rate control treatment strategies for atrial fibrillation (AF) continues, a new study released on June 4 in the Archives of Internal Medicine compares the effectiveness of both treatment strategies to decrease mortality in a population-based setting with long-term follow-up.

The study, which focused on more than 26,000 patients in Quebec, Canada, between 1999 and 2007 who were 66 years or older hospitalized with an AF diagnosis who did not have AF-related drug prescriptions in the year before the admission but received a prescription within seven days of discharge, found little difference in mortality within four years of treatment initiation in AF patients undergoing either treatment. However, rhythm control therapy seemed to be superior over the long term. According to the study, the mortality rate was similar between the two groups up through the fourth year, but decreased steadily in the rhythm control group after five years.

Additional Resources Journal Scan: AFFIRM Trial 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With AFib CardioSource Clinical Community: Atrial Fibrillation CardioSmart Patient Factsheet: Atrial Fibrillation

"We found that with increasing follow-up time the mortality among the patients who newly initiated rhythm control therapy gradually decreased relative to those who initiated rate control drugs, reaching 23 percent reduction after eight years of follow-up," the study authors note.

Up until the 2002 publication of the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial, which concluded there were no differences in mortality between the two treatments, rhythm control was generally considered superior. Since then, clinical guidelines have indicated either treatment to be suitable.

However, according to the authors of this latest study, these new results "suggest that a strategy of rhythm control is associated with lower long-term mortality." They recommend future studies assess the long-term benefits of rhythm control drugs in AF, and also suggest "that the development of antiarrhythmic drugs with fewer adverse effects but retained or improved efficacy may result in important gains" in reducing AF patient mortality.

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