AF-CHF
Trial question
Is a rhythm-control strategy superior to a rate-control strategy in patients with AF and congestive HF?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
18.0% female
82.0% male
N = 1376
1376 patients (254 female, 1122 male)
Inclusion criteria: patients with an LVEF ≤ 35%, symptoms of congestive HF, and a history of AF
Key exclusion criteria: persistent AF for > 12 months, a reversible cause of AF or HF, decompensated HF within 48 hours before intended randomization, the use of antiarrhythmic drugs for other arrhythmias, second-degree or third-degree AV block, a history of the long-QT syndrome, previous ablation of an atrioventricular node, anticipated cardiac transplantation within 6 months, renal failure requiring dialysis
Interventions
N=682 rhythm control (maintenance of sinus rhythm)
N=694 rate control (control of the ventricular rate)
Primary outcome
Death from cardiovascular causes
27
25
27.0 %
20.3 %
13.5 %
6.8 %
0.0 %
Rhythm control
Rate control
No significant difference ↔
No significant difference in death from cardiovascular causes (27% vs. 25%; HR 1.06, 95% CI 0.86 to 1.3)
Secondary outcomes
No significant difference in death from any cause (32% vs. 33%; RR 0.97, 95% CI -3.45 to 5.39)
Conclusion
In patients with an LVEF ≤ 35%, symptoms of congestive HF, and a history of AF, rhythm control was not superior to rate control with respect to death from cardiovascular causes.
Reference
Roy D, Talajic M, Nattel S et al. Rhythm control versus rate control for atrial fibrillation and heart failure. N Engl J Med. 2008 Jun 19;358(25):2667-77.
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