Trial reportJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing2021
Pharmacological rhythm versus rate control in patients with atrial fibrillation and heart failure: the CASTLE-AF trial.
Trial report in Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
12 citing papers in PubMed, 28 citations in OpenAlex.
- Early Rhythm Versus Rate Control in Older Adults With New-Onset Atrial Fibrillation: A Propensity Score-Matched Analysis.Journal of arrhythmia · 2026Article
- Calcium Channel Blockers in Critical Care Medicine: Current Clinical Applications and Future Investigational Perspectives.Medical sciences (Basel, Switzerland) · 2026Review
- How Early Is Early?: Optimizing Timing of Catheter Ablation for Atrial Fibrillation in Heart Failure.JACC. Asia · 2024Article
- Early Cryoablation After First Diagnosis of Atrial Fibrillation Reduces Arrhythmia Recurrence in Heart Failure Patients.JACC. Asia · 2024Article
- Hybrid Endo-Epicardial Therapies for Advanced Atrial Fibrillation.Journal of clinical medicine · 2024Review
- Atrial fibrillation and stroke prevention: 25 years of research at EP Europace journal.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023Review
- Atrial Fibrillation: Rate Versus Rhythm Control.HCA healthcare journal of medicine · 2023Review
- Hybrid Ablation of Nonparoxysmal Atrial Fibrillation: The Convergent and Totally Thoracoscopic Approaches.Reviews in cardiovascular medicine · 2022Review
- Pharmacologic Rate versus Rhythm Control for Atrial Fibrillation in Heart Failure Patients.Medicina (Kaunas, Lithuania) · 2022Review
- Cryoballoon Ablation for the Treatment of Atrial Fibrillation in Patients With Concomitant Heart Failure and Either Reduced or Preserved Left Ventricular Ejection Fraction: Results From the Cryo AF Global Registry.Journal of the American Heart Association · 2021Article
- Impact of Rhythm vs. Rate Control in Atrial Fibrillation on the Long-Term Outcome of Patients Undergoing Transcatheter Edge-to-Edge Mitral Valve Repair.Journal of clinical medicine · 2021Article
- Comparison of rhythm versus rate control of atrial fibrillation in heart failure subgroups: Systematic review and meta-analysis of randomized controlled trials.Indian pacing and electrophysiology journalReview
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors at 8 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe value of antiarrhythmics to maintain normal sinus rhythm in patients with atrial fibrillation (AF) and heart failure (HF) is still being debated. We aimed to determine whether rhythm control using antiarrhythmic drugs (AADs) is more effective than rate control in improving outcomes in this population.
methodIn this sub-analysis of the CASTLE-AF study, we included patients that were treated pharmacologically either to maintain sinus rhythm or to achieve rate control. The primary endpoint was defined as a composite of death from any cause or worsening of HF that led to an unplanned overnight hospitalization.
resultAmong 210 patients (mean age of 64.1 ± 10.8 years, 83.3% male) treated pharmacologically, 60 patients were in the rhythm control group and 150 were in the rate control group. Patients in the rhythm control group were less likely to be assigned a beta-blocker (53 (88.3%) vs 141 (97.9%), P = 0.004) and digitalis (8 (13.3%) vs 53 (36.8%), P < 0.001). Over a median follow-up of 3.76 (95% confidence interval (CI), 3.23, 4.48) years, the primary composite endpoint of all-cause mortality and HF admissions occurred in 23 patients (38.3%) in the rhythm control arm vs 67 (44.7%) in the rate control arm (hazard ratio, 0.99; 95% CI, 0.62 to 1.60; P = 0.976).
conclusionIn CASTLE-AF among AF patients with HF, rhythm control with AADs did not significantly reduce the primary composite endpoint of all-cause mortality and HF hospitalization when compared with a pharmacological rate control strategy.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.