Rhythm therapy versus rate control for long-term management of recurrent atrial fibrillation
Institute for Clinical Systems Improvement
Record ID 32003001180
English
Authors' objectives:
This review aims to assess the available evidence on rhythm therapy versus rate control for long-term management of recurrent atrial fibrillation (AF).
Authors' recommendations:
With regard to rhythm therapy versus rate control for long-term management of recurrent atrial fibrillation (AF), the ICSI Technology Assessment Committee finds:
There is no observed survival advantage to strategies aimed at restoring sinus rhythm over strategies to control rate in older patients with relatively asymptomatic atrial fibrillation based on the limited data available from studies which have compared these strategies (Conclusion Grade II).
Strategies aimed at restoring sinus rhythm were associated with a higher incidence of hospitalization and adverse drug effects.
A strategy of rate control is an acceptable treatment option for older patients with recurrent or persistent atrial fibrillation who are asymptomatic or minimally symptomatic. The studies suggest that a rate control strategy should be reconsidered in patients in whom initial attempts at restoration of sinus rhythm have been ineffective or associated with side effects particularly if restoration of sinus rhythm did not result in significant symptomatic improvement.
Patients with atrial fibrillation with risk factors for thromboembolism should be considered for the warfarin anticoagulation. Early discontinuation of anticoagulation and subtherapeutic anticoagulation are factors associated with thromboembolic events.
Current randomized trials comparing rhythm therapy to rate control have included older patients with relatively asymptomatic, recurrent AF. Conclusions cannot be generalized to patients outside of these groups such as patients with symptomatic atrial fibrillation, first detected episodes of atrial fibrillation, or younger patients with atrial fibrillation.
Authors' methods:
Review
Details
Project Status:
Completed
URL for project:
http://www.icsi.org/index.asp
Year Published:
2003
English language abstract:
An English language summary is available
Publication Type:
Not Assigned
Country:
United States
MeSH Terms
- Anti-Arrhythmia Agents
- Electric Countershock
- Atrial Fibrillation
Contact
Organisation Name:
Institute for Clinical Systems Improvement
Contact Address:
8009 34th Avenue South, Suite 1200, Bloomington, MN, USA. Tel: +1 952 814 7060; Fax: +1 952 858 9675
Contact Name:
icsi.info@icsi.org
Contact Email:
icsi.info@icsi.org
Copyright:
Institute for Clinical Systems Improvement (ICSI)
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.