title: Rhythm control versus rate control in patients with persistent atrial fibrillation. Results of the HOT CAFE Polish Study.
abstract: BACKGROUND
  Patients with atrial fibrillation (AF) can be managed either by maintaining sinus rhythm using antiarrhythmic drugs and/or electrical cardioversion, or by leaving patients in AF and controlling ventricular rate without attempts to restore sinus rhythm. Which of these two strategies is superior, has not yet been definitively established.
  
  
  OBJECTIVE
  HOT CAFE Polish Study (How To Treat Chronic Atrial Fibrillation) was designed to evaluate in a randomised, multicentre and prospective manner the risks and advantages of two therapeutical strategies - rate control or rhythm control, in patients with persistent AF.
  
  
  METHODS
  The study group consisted of 205 patients (71 females and 134 males; mean age 60.8+/-11.2 years) with a mean time of AF duration of 273.7+/-112.4 days; 101 patients were randomly assigned to rate control (Group I) whereas 104 patients were randomised to sinus rhythm (SR) restoration by DC cardioversion (CV) and subsequent antiarrhythmic drug treatment (Group II). At the end of follow-up (12 months) SR was present in 75% of patients.
  
  
  RESULTS
  The incidence of hospital admissions was higher in group II in comparison to group I (12% vs 74%; p<0.001). Mortality was similar in both groups (1.0% versus 2.9%, NS). In both groups a significant improvement of heart failure symptoms was observed during the first 2 months (p<0.02 and p<0.001). In group II exercise tolerability measured by maximal workload during treadmill test significantly improved compared with baseline (5.2+/-5.1 vs 7.6+/-3.3 MET; p<0.0001). In patients in whom SR was restored, the left ventricular function improved and an increase in the shortening fraction was observed (29+/-7% vs 31+/-7%; p<0.01). No thromboembolic complications were observed in patients left with AF. Three patients from group II suffered ischaemic stroke; in two cases stroke was associated with CV whereas in the third patient - with late AF recurrence.
  
  
  CONCLUSIONS
  The HOT CAFE Polish Study did not reveal significant differences in mortality between the two treatment strategies in patients with persistent AF. Although patients with SR had better improvement in some haemodynamical parameters, the hospitalisation rate was higher and the incidence of stroke was not reduced compared with the rate control group.
authors.affiliation: Chair and Department of Internal Medicine and Cardiology, Medical Academy, Warsaw, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Opolski
authors.forename: Adam
authors.initials: A
authors.lastname: Torbicki
authors.forename: Dariusz
authors.initials: D
authors.lastname: Kosior
authors.forename: Marcin
authors.initials: M
authors.lastname: Szulc
authors.forename: Maria
authors.initials: M
authors.lastname: Zawadzka
authors.forename: Magdalena
authors.initials: M
authors.lastname: Pierścińska
authors.forename: Piotr
authors.initials: P
authors.lastname: Kołodziej
authors.forename: Marek
authors.initials: M
authors.lastname: Stopiński
authors.forename: Beata
authors.initials: B
authors.lastname: Wozakowska-Kapłon
authors.forename: Piotr
authors.initials: P
authors.lastname: Achremczyk
authors.forename: Daniel
authors.initials: D
authors.lastname: Rabczenko
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000628:therapy*; D002908:Chronic Disease; D004554:Electric Countershock / Q000379:methods*; D015716:Electrocardiography, Ambulatory; D005260:Female; D006329:Heart Conduction System / Q000187:drug effects / Q000503:physiopathology*; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000517:prevention & control; D013997:Time Factors
chemical_list: D000889:Anti-Arrhythmia Agents