Lenient rate control in atrial fibrillation

The debate on rate vs rhythm control is still on, though the evidence is more in favour of rate control. Now there is a question on lenient vs strict rate control in atrial fibrillation. By lenient rate control, what is aimed at is to maintain the resting heart rate below 110 beats/minute where as in strict rate control the target is below 80 beats/minute. Most of the guidelines advice strict rate control. We are aware that higher rates would increase the chance for tachycardiomyopathy. A recent study published in the New England Journal of Medicine (N Engl J Med 2010; 362:1363-137) compared these two strategies. A composite of cardiovascular death, heart failure hospitalization, stroke, bleeding, systemic embolic episodes and life threatening arrhythmic events was the primary outcome measure. The follow up period was between two to three years. The primary composite outcome was lower in the lenient control group with a P<0.001 for non-inferiority between the two strategies. The symptomatic status and frequency of adverse events were similar in the two groups. The authors concluded that lenient rate control is as good as strict rate control in permanent atrial fibrillation and an easier target to achieve.

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