Rate control and rhythm control strategies have been associated with similar rates of stroke and death in patients with chronic atrial fibrillation (Arch Intern Med 2005 Feb 14;165(3):258). A target heart rate of 60-80 beats per minute has been suggested by the American College of Cardiology, but this has not been based on studies with clinical outcomes. To address this issue, a randomized trial compared “lenient” rate control (resting heart rate < 110 beats/minute) vs. “strict” rate control (resting heart rate < 80 beats/minute and heart rate during moderate exercise < 110 beats/minute) in patients with permanent atrial fibrillation. The desired rate control was achieved through the use of beta blockers, calcium channel blockers, and digoxin, alone or in combination. The primary outcome was a composite of death, hospitalization for heart failure, stroke, major bleeding, or significant arrhythmic events. The 3-year estimated cumulative incidence of the primary composite outcome was 12.9% with lenient control vs. 14.9% with strict control (level 2 [mid-level] evidence). There were no significant differences between groups in rates of dyspnea, fatigue, palpitations, or New York Heart Association (NYHA) functional class. The authors concluded that lenient rate control was as effective as strict rate control for the prevention of major cardiovascular events (N Engl J Med. 2010 Apr 15;362(15):1363).
For more information, see the Rate control in atrial fibrillation topic in DynaMed.