title: Optimal treatment strategy for patients with paroxysmal atrial fibrillation: J-RHYTHM Study.
abstract: 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).
authors.affiliation: Department of cardiology, Keio University, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ogawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamashita
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Yamazaki
authors.forename: Yoshifusa
authors.initials: Y
authors.lastname: Aizawa
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Atarashi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Inoue
authors.forename: Tohru
authors.initials: T
authors.lastname: Ohe
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ohtsu
authors.forename: Ken
authors.initials: K
authors.lastname: Okumura
authors.forename: Takao
authors.initials: T
authors.lastname: Katoh
authors.forename: Shiro
authors.initials: S
authors.lastname: Kamakura
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kumagai
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kurachi
authors.forename: Itsuo
authors.initials: I
authors.lastname: Kodama
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Koretsune
authors.forename: Tetsunori
authors.initials: T
authors.lastname: Saikawa
authors.forename: Masayuki
authors.initials: M
authors.lastname: Sakurai
authors.forename: Kaoru
authors.initials: K
authors.lastname: Sugi
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Tabuchi
authors.forename: Haruaki
authors.initials: H
authors.lastname: Nakaya
authors.forename: Toshio
authors.initials: T
authors.lastname: Nakayama
authors.forename: Makoto
authors.initials: M
authors.lastname: Hirai
authors.forename: Masahiko
authors.initials: M
authors.lastname: Fukatani
authors.forename: Hideo
authors.initials: H
authors.lastname: Mitamura
mesh_terms: 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
chemical_list: D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D002121:Calcium Channel Blockers