SynthesisBritish journal of clinical pharmacology2005
Rhythm vs. rate control of atrial fibrillation meta-analysed by number needed to treat.
Synthesis in British journal of clinical pharmacology, 2005. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03432663 (Using Time-dependent Intravenous Infusions of Amiodarone for Conversions to Sinus Rhythms in Patients With Paroxysmal Atrial Fibrillation), which is not on this map. Cited by 14 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Using Time-dependent Intravenous Infusions of Amiodarone for Conversions to Sinus Rhythms in Patients With Paroxysmal Atrial Fibrillation
Who cites it
14 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Pooled it
- Atrial fibrillation (chronic).BMJ clinical evidence · 2011Pooled it
- Atrial fibrillation (chronic).BMJ clinical evidence · 2008Pooled it
- Review
- Computational models of atrial fibrillation: achievements, challenges, and perspectives for improving clinical care.Cardiovascular research · 2021Review
- Treatment timing and the effects of rhythm control strategy in patients with atrial fibrillation: nationwide cohort study.BMJ (Clinical research ed.) · 2021Observational
- Choice and Outcomes of Rate Control versus Rhythm Control in Elderly Patients with Atrial Fibrillation: A Report from the REPOSI Study.Drugs & aging · 2018Article
- Practical Issues to Prevent Stroke Associated with Non-valvular Atrial Fibrillation.Journal of stroke · 2013Review
- Current Evidence and Recommendations for Rate Control in Atrial Fibrillation.Arrhythmia & electrophysiology review · 2013Article
- Rate versus rhythm control in atrial fibrillation.Canadian family physician Medecin de famille canadien · 2013Article
- Rate versus rhythm in atrial fibrillation: and how slow do you go?Canadian family physician Medecin de famille canadien · 2011Article
- Update on anti-coagulation in atrial fibrillation.QJM : monthly journal of the Association of Physicians · 2011Review
- Prevention of atrial fibrillation: report from a national heart, lung, and blood institute workshop.Circulation · 2009Article
- One hundred years of atrial fibrillation.British journal of clinical pharmacology · 2005Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundWhenever feasible, rhythm control of atrial fibrillation (AF) was generally preferred over rate control, in the belief that it offered better symptomatic relief and quality of life, and eliminated the need for anticoagulation. However, recent trials appear to challenge these assumptions.
aimsTo explore the desirability of rhythm vs. rate control of AF by systematic review of pertinent, published, randomized controlled trials (RCTs) and a meta-analysis by number needed to treat (NNT) year(-1), with respect to diverse clinically important outcomes.
methodsRCTs of outcome primarily comparing rate vs. rhythm control in patients with spontaneous AF were identified. For each outcome and assuming rhythm control to be the active treatment, relative risk reduction (RRR) and NNT year(-1) were derived for individual trials together with an NNT year(-1) for all trials combined; corresponding 95% confidence intervals (CI) were also calculated. Adverse drug reaction (ADR) and quality of life reporting were also assessed.
resultsIn all, data from five suitable RCTs (entailing 5239 patients) were analysed. For hospitalization, available RRRs and NNT year(-1) values were all clinically and statistically significant. Overall, one additional patient was hospitalized for every 35 assigned to rhythm control (95% CI 27, 48). For the endpoints of death, 'ischaemic' stroke and 'non-CNS' bleeding, there was no significant difference. ADRs were significantly more common in rhythm control patients, whereas quality of life assessments revealed no difference. Thromboembolism was associated with cessation of or subtherapeutic anticoagulation, irrespective of treatment assignment.
conclusionReduced risk of hospitalization and non-inferiority for other endpoints all favour rate control, the less costly strategy. If symptoms of AF are not a problem, treatment should target optimizing rate control and more widespread and effective prophylactic anticoagulation.
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