Atrial fibrillation is the in the g...

Atrial fibrillation is the in the greatest degree common cardiac arrhythmia, affecting about 23 million individuals in the United States. [i]role[/i]s with atrial fibrillation have a four to five times greater risk of affliction and twice the risk of death. There are couple approaches to management of atrial fibrillation: rate sway and rhythm control. In rate restrain medication is used to interrupt thromboembolic events. In rhythm hinder electric or pharmacologic cardioversion to sinus metre is followed by administration of antiarrhythmic agents to maintain this metre Both strategies have risks and benefits with regard to morbidity and mortality. new studies have sought to determine which of these couple strategies result in better clinical issues De Denus and associates performed a meta-analysis of published studies to evaluate rate versus periodical emphasis control in terms of patient outcomes

The authors searched MEDLINE, the Cochrane Controll Trials Registry, and the International Pharmaceutical Abstracts database to identify randomized controll trials comparing rate and verse control strategies as first-line therapies. Trials were exclud if they included patients who had undergone surgery or if they evaluated invasive or surgical interventions as first-line therapy for atrial fibrillation. The authors extracted data and assessed the quality of trials based onward established criteria. The data were given a quality rating according to the risk for bias: (A) low--all quality criteria were met; (B) moderate--one or more quality criteria were merely partly met; or (C) high--one or more criteria were not met

Five published trials with a total of 5239 patients met the inclusion criteria. In the individual trials, there were no significant differences in all-cause mortality when rate bridle was compared with rhythm have charge of When the data were pond ed there still was no significant difference in all-cause mortality rates between rate-control and rhythm-control disposes (13.0 and 14.6 percent, respectively; left over s ratio, 0.87; 95% confidence interval, 074 to 102; P = 09) However, there was a positive run in the rate-control group. The lakeed data showed no significant difference in the rate of ischemic blow between the rate-control and the rhythm-control groups

The authors deduce that in patients with persistent atrial fibrillation, or with atrial fibrillation that is likely to reoccur rate direct in combination with anticoagulation looks to be comparable with attempting to maintain sinus number They add that the rhythm-control strategy may be indicated in rareed patients, although it should not be the preferr strategy in all patients with atrial fibrillation.

KARL E MILLER, MD

De Denus s et al. Rate vs number control in patients with atrial fibrillation: a meta-analysis. Arch Intern M February 14 2005;165:258-62

COPYRIGHT 2005 American Academy of Family Physicians

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