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Yonsei Med J. 2018 Mar;59(2):258-264. doi: 10.3349/ymj.2018.59.2.258.

Comparison of Rhythm and Rate Control Strategies for Stroke Occurrence in a Prospective Cohort of Atrial Fibrillation Patients.

Author information

1
Division of Cardiology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea.
2
Division of Cardiology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea. kwkang@eulji.ac.kr.
3
Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
4
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
5
Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea.
6
Department of Cardiology, School of Medicine, Ewha Womans University, Seoul, Korea.
7
Department of Cardiology, Hanyang University Seoul Hospital, Seoul, Korea.
8
Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea.
9
Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
10
Department of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
11
Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
12
Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea.
13
Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea. cby6908@yuhs.ac.
#
Contributed equally

Abstract

PURPOSE:

Comparisons of rhythm and rate control strategies for stroke prevention in patients with atrial fibrillation (AF) are still inconclusive. We compared differences in clinical outcomes between the rhythm and rate control strategies.

MATERIALS AND METHODS:

The COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) registry prospectively enrolled 6000 patients who were treated for AF using real-world guideline adherence at multiple referral centers. In total, 2508 (41.8%) patients were clinically followed up for over six months. Of these, 1134 (45.2 %) patients treated by rhythm control and 1374 (54.8 %) patients treated by rate control were analyzed for clinical outcomes, including stroke and cardiovascular outcomes.

RESULTS:

Among all patients (age, 68±10 years; male, 62.4%), those treated with the rhythm control strategy were significantly younger, had more symptomatic paroxysmal AF, and a shorter AF duration, and were less likely to have diabetes, renal dysfunction, and heart failure, compared to those treated with the rate control strategy (CHA₂DS₂-VASc score 2.4±1.5 vs. 3.1±1.7, p<0.001). Even though oral anticoagulation was similarly prescribed in both groups, occurrence of stroke was less likely to occur in the rhythm control strategy group (0.0% vs. 0.7%, p=0.015). Multivariate Cox hazard regression showed that only age, especially more than 75 years old, were significantly correlated with the occurrence of stroke, regardless of the strategy used for treatment.

CONCLUSION:

In this prospective AF cohort, compared with the rate control strategy, the rhythm control strategy was associated with fewer cardiovascular events and strokes in a short-term period.

KEYWORDS:

Atrial fibrillation; rate control; rhythm control; stroke

PMID:
29436194
PMCID:
PMC5823828
DOI:
10.3349/ymj.2018.59.2.258
[Indexed for MEDLINE]
Free PMC Article

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