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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)?
Methods:
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).
Results:
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.
Conclusions:
QOL in patients with permanent AF is not influenced by whether the degree of rate control is lenient or strict.
Perspective:
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.
Keywords: Quality of Life, Exercise, Fatigue, Dyspnea, Catheter Ablation, Pregnancy
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