title: Temporal Patterns and Predictors of Rate vs Rhythm Control in Patients Attending a Multidisciplinary Atrial Fibrillation Clinic.
abstract: Contemporary trends in the selection of and persistence with rate vs rhythm control for atrial fibrillation (AF) are not well studied, particularly in the context of multidisciplinary AF clinics.
  
  
  
  The initial arrhythmia management strategy in 1031 consecutive patients attending a multidisciplinary AF clinic from 2005-2012 was analyzed.
  
  
  
  The 397 (38.5%) patients initially treated with rhythm control were younger (57.4 ± 14 years vs 65.6 ± 13 years; P < 0.0001) and more likely to be men (64.5% vs 56.9%; P = 0.019). They also had fewer comorbidities, lower CHADS2(Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke/Transient Ischemic Attack) scores, and greater symptom burden. The proportion treated with rhythm control declined from 46.9% in 2005-2006 to 28.4% in 2012 (P for trend < 0.0001). Compared with those initially selecting rate control, patients treated with rhythm control required more frequent clinic encounters (7 [interquartile range {IQR}, 3-12] vs 3 [IQR, 2-7]; P < 0.001) and longer follow-up (266 days [IQR, 84-548 days] vs 99 days [IQR, 0-313 days]; P < 0.001). Younger age, absence of diabetes and sleep apnea, earlier treatment year, higher symptom burden, and rural residence were independently associated with rhythm control. Persistence with the initial treatment strategy was reduced in the rhythm-control group (P = 0.003).
  
  
  
  Use of rhythm control as the initial arrhythmia management strategy for AF in a specialty AF clinic is declining. Rhythm control requires more intensive follow-up and was more likely to lead to a change in arrhythmia management strategy.
authors.affiliation: Cardiac Arrhythmia Service, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cuming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: jorge.wong@mail.harvard.edu.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Wong
authors.affiliation: Cardiac Arrhythmia Service, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cuming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: F Russell
authors.initials: FR
authors.lastname: Quinn
authors.affiliation: Cardiac Arrhythmia Service, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cuming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Gillis
authors.affiliation: Cardiac Arrhythmia Service, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cuming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Laurie
authors.initials: L
authors.lastname: Burland
authors.affiliation: Cardiac Arrhythmia Service, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cuming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Guanmin
authors.initials: G
authors.lastname: Chen
authors.affiliation: Cardiac Arrhythmia Service, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cuming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: D George
authors.initials: DG
authors.lastname: Wyse
authors.affiliation: Cardiac Arrhythmia Service, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cuming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Wilton
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000416:Alberta; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000628:therapy*; D017115:Catheter Ablation / Q000706:statistics & numerical data; D003266:Continuity of Patient Care; D004363:Drug Utilization / Q000706:statistics & numerical data; D004554:Electric Countershock / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012424:Rural Population; D012737:Sex Factors
chemical_list: D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents