The Effect of Rate Control on Quality of Life in Patients With Permanent Atrial Fibrillation: Data From the RACE II (Rate Control Efficacy in Permanent Atrial Fibrillation II) Study

Study Questions:

Does strict rate control improve quality of life (QOL) to a greater degree than lenient rate control in patients with permanent atrial fibrillation (AF)?


QOL was measured at baseline, 1 year of follow-up, and at a median of 3 years of follow-up in 437 patients (mean age 68 years) with permanent AF randomly assigned to lenient rate control (resting rate <110 bpm, n = 230) or strict rate control (resting rate <80 bm and rate <110 bpm during moderate exercise, n = 207). QOL was measured with the Short-Form Health Survey (SF-36), University of Toronto AF Severity Scale, and the Multidimensional Fatigue Inventory-20 (MFI-20).


At baseline, 58% of patients had symptoms of dyspnea, fatigue, and/or palpitations, and there were no significant differences between the lenient and strict groups in the SF-36, AF severity scale, or MFI-20. There were no significant differences in these QOL instruments at follow-up versus baseline, or between the lenient- and strict-control groups during follow-up.


QOL in patients with permanent AF is not influenced by whether the degree of rate control is lenient or strict.


Of note is that highly symptomatic patients were not included in this study and that 42% of patients in this study had no symptoms at all. Therefore, the results of the study do not apply to patients with prominent exertional symptoms. When effort intolerance is associated with a rate >120 bpm, there typically is a meaningful improvement in effort tolerance (and QOL) with strict rate control.

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Exercise

Keywords: Quality of Life, Exercise, Fatigue, Dyspnea, Catheter Ablation, Pregnancy

< Back to Listings