Real-Life Observations of Clinical Outcomes With Rhythm- and Rate-Control Therapies for Atrial Fibrillation: RECORDAF (Registry on Cardiac Rhythm Disorders Assessing the Control of Atrial Fibrillation)

Jul 18, 2011
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Authors:
Camm AJ, Breithardt G, Crijns H, et al.
Citation:
J Am Coll Cardiol 2011;58:493-501.
Summary By:
Fred Morady, MD, FACC

Study Questions:

What are the outcomes of rhythm- and rate-control strategies for atrial fibrillation (AF) in clinical practice?

Methods:

Data from 5,604 patients (mean age 66 years) enrolled in a longitudinal AF registry were analyzed upon enrollment and at 6 and 12 months of follow-up. Therapeutic success was defined as an unchanged treatment strategy and the absence of clinical events, along with sinus rhythm at 12 months in the rhythm-control group (n = 3,076) or a resting heart rate <80 bpm at 12 months in the rate-control group (n = 2,528).

Results:

At 12 months, 81% of patients in the rhythm-control group and 33% of patients in the rate-control group were in sinus rhythm. A vitamin K antagonist was used for stroke prevention in 52% of patients overall and in 59% of patients with a CHADS2 score ≥2. Therapeutic success was achieved in 60% of patients in the rhythm-control group compared to 47% in the rate-control group. The clinical outcomes that differed significantly between the rhythm- and rate-control groups were cardiovascular death (0.9 vs. 2.8%, respectively), stroke/transient ischemic attack (1.7 vs. 2.8%, respectively), hospitalization for arrhythmia/proarrhythmia (11.3 vs. 7.3%, respectively), and heart failure (2.4 vs. 4.8%, respectively). Adverse outcomes were related to renal disease, coronary disease, heart failure, prior stroke, and age, but not to the management strategy.

Conclusions:

The authors concluded that adverse outcomes during follow-up in patients with AF are largely a function of age and comorbidities, not the management strategy.

Perspective:

Despite the results of clinical trials (e.g., AFFIRM) that showed no advantage of a rhythm-control strategy over a rate-control strategy, it appears that the rhythm-control approach continues to be favored in clinical practice.

Keywords: Follow-Up Studies, Ischemic Attack, Transient, Heart Failure, Comorbidity, Coronary Disease, Atrial Fibrillation, Hospitalization


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