Optimal treatment strategy for patients with paroxysmal atrial fibrillation: J-RHYTHM Study.
Background Although previous clinical trials demonstrated the non-inferiority of a rate control to rhythm control strategy for management of atrial fibrillation (AF), the optimal treatment strategy for paroxysmal AF (PAF) remains unclear. Methods and Results A randomized, multicenter comparison of rate control vs rhythm control in Japanese patients with PAF (the Japanese Rhythm Management Trial for Atrial Fibrillation (J-RHYTHM) study) was conducted. The primary endpoint was a composite of total mortality, symptomatic cerebral infarction, systemic embolism, major bleeding, hospitalization for heart failure, or physical/psychological disability requiring alteration of treatment strategy. In the study, 823 patients with PAF were followed for a mean period of 578 days. The primary endpoint occurred in 64 patients (15.3%) assigned to rhythm control and in 89 patients (22.0%) to rate control (P=0.0128). No significant differences between the treatment strategies were observed in the incidences of death, stroke, bleeding and heart failure. Meanwhile, significantly fewer patients requested changes of assigned treatment strategy in the rhythm control vs the rate control group, which was accompanied by improvement in AF-specific quality of life scores. Conclusion The J-RHYTHM study showed that rhythm control was associated with fewer primary endpoints than rate control. However, mortality and cardiovascular morbidity were not affected by the treatment strategy (umin-CTR No. C000000106).
Ogawa
Satoshi
S
Department of cardiology, Keio University, Tokyo, Japan.
Yamashita
Takeshi
T
Yamazaki
Tsutomu
T
Aizawa
Yoshifusa
Y
Atarashi
Hirotsugu
H
Inoue
Hiroshi
H
Ohe
Tohru
T
Ohtsu
Hiroshi
H
Okumura
Ken
K
Katoh
Takao
T
Kamakura
Shiro
S
Kumagai
Koichiro
K
Kurachi
Yoshihisa
Y
Kodama
Itsuo
I
Koretsune
Yukihiro
Y
Saikawa
Tetsunori
T
Sakurai
Masayuki
M
Sugi
Kaoru
K
Tabuchi
Toshifumi
T
Nakaya
Haruaki
H
Nakayama
Toshio
T
Hirai
Makoto
M
Fukatani
Masahiko
M
Mitamura
Hideo
H
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000494:pharmacology / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000208:ethnology / Q000503:physiopathology*; D002121:Calcium Channel Blockers / Q000494:pharmacology / Q000627:therapeutic use; D023381:Endpoint Determination; D005260:Female; D006329:Heart Conduction System / Q000187:drug effects / Q000503:physiopathology*; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012849:Sinoatrial Node / Q000187:drug effects / Q000503:physiopathology
D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D002121:Calcium Channel Blockers