title: Rate vs rhythm control in patients with atrial fibrillation and heart failure: a systematic review and meta-analysis of randomised controlled trials.
abstract: BACKGROUND
  Atrial fibrillation (AF) is a common arrhythmia that can promote or worsen heart failure (HF). Our purpose was to compare the effects of rate and rhythm control in patients with atrial fibrillation and heart failure.
  
  
  METHODS
  We developed a systematic search in August 2010 through CENTRAL and MEDLINE databases to identify randomised controlled trials (RCTs) comparing rate control with rhythm control in patients with both AF and HF. We analysed mortality, hospitalisations, stroke/thromboembolic events, quality of life, and drugs adverse events. Relative risks (RR) and 95% confidence intervals (95% CI) were calculated for mortality and hospitalisations. The remaining outcomes were analysed qualitatively.
  
  
  RESULTS
  Four RCTs with a total of 2486 patients with atrial fibrillation and heart failure were identified. Mortality and stroke/thromboembolic events were not significantly different in rate and rhythm control arms [RR 1.03; 95% CI: 0.90-1.17] and [RR 1.09; 95% CI: 0.61-1.96], respectively. Hospitalisations were less frequent with rate control than with rhythm control [RR 0.92; 95% CI: 0.86-0.98; p=0.008], in 3 studies involving 2425 patients. Number needed to treat to prevent one hospitalisation was 19 patients.
  
  
  CONCLUSIONS
  In patients with AF and HF, rate control compared with rhythm control showed inferior risk of hospitalisation.
authors.affiliation: Clinical Pharmacology and Therapeutics Laboratory, Faculty of Medicine, Lisbon, Portugal.
authors.forename: Daniel
authors.initials: D
authors.lastname: Caldeira
authors.forename: Cláudio
authors.initials: C
authors.lastname: David
authors.forename: Cristina
authors.initials: C
authors.lastname: Sampaio
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D018450:Disease Progression; D004554:Electric Countershock; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome