Randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation: the Strategies of Treatment of Atrial Fibrillation (STAF) study.
OBJECTIVE
This study was designed to compare two treatment strategies in patients with atrial fibrillation(AF): rhythm-control (restoration and maintenance of sinus rhythm) and rate-control (pharmacologic or invasive rate-control and anticoagulation).


BACKGROUND
Atrial fibrillation is the most common arrhythmia. It is unclear whether a strategy of rhythm- or rate-control is better in terms of mortality, morbidity, and quality of life.


METHODS
The Strategies of Treatment of Atrial Fibrillation (STAF) multicenter pilot trial randomized 200 patients (100 per group) with persistent AF to rhythm- or rate-control. The combined primary end point was a combination of death, cardiopulmonary resuscitation, cerebrovascular event, and systemic embolism.


RESULTS
After 19.6 +/- 8.9 months (range 0 to 36 months) there was no difference in the primary end point between rhythm-control (9/100; 5.54%/year) and rate-control (10/100; 6.09%/year; p = 0.99). The percentage of patients in sinus rhythm in the rhythm-control group after up to four cardioversions during the follow-up period (rate-control group) was 23% (0%) at 36 months. Eighteen primary end points occurred in atrial fibrillation; only one occurred in sinus rhythm (p = 0.049).


CONCLUSIONS
The STAF pilot study showed no differences between the two treatment strategies in all end points except hospitalizations. These data suggest that there was no benefit in attempting rhythm-control in these patients with a high risk of arrhythmia recurrence. It remains unclear whether the results in the rhythm-control group would have been better if sinus rhythm had been maintained in a higher proportion of patients, as all but one end point occurred during AF.
Carlsson
Jörg
J
Department of Internal Medicine II, Klinikum Lippe-Detmold, Röntgenstrasse 18, D-32760 Detmold, Germany. Joerg.Carlson@Klinikum-Lippe.de
Miketic
Sinisa
S
Windeler
Jürgen
J
Cuneo
Alessandro
A
Haun
Sebastian
S
Micus
Stefan
S
Walter
Sabine
S
Tebbe
Ulrich
U
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy*; D001283:Atrioventricular Node / Q000601:surgery; D017115:Catheter Ablation; D017147:Defibrillators, Implantable; D018572:Disease-Free Survival; D004554:Electric Countershock; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011788:Quality of Life; D013015:Sotalol / Q000627:therapeutic use; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants; D013015:Sotalol