Rhythm Versus Rate Control for Atrial Fibrillation: A Meta-analysis of Randomized Controlled Trials
Abdelrahman Ibrahim Abushouk1,2, Aya Ashraf Ali3,4, Ahmed Abdou Mohamed3,4, Loalo'a El-Sherif3,4, Mennat-Allah Abdelsamed4,5, Mohamed Kamal Mohamed4,5, Merhan Kamal Sayed3,4, Nehal Alaa Mohamed3,4, Ahmed Abdelbaset Osman3,4, Sameh M Shaheen1 and Mohamed M. Abdel-Daim6

1Faculty of Medicine, Ain Shams University, Cairo, Egypt.

2NovaMed Medical Research Association, Cairo, Egypt.

3Faculty of Medicine, Minia University, Minia, Egypt.

4Minia Medical Research Society, Minia University, Minia, Egypt.

5Faculty of Clinical Pharmacy, Minia University, Minia, Egypt.

6Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt.

Corresponding Author E-mail: Abdeldaim.m@vet.suez.edu.eg

Abstract: Atrial fibrillation (AF) is a common, sustained tachyarrhythmia, associated with an increased risk of mortality and thromboembolic events. We performed this meta-analysis to compare the clinical efficacy of rate and rhythm control strategies in patients with AF in a meta-analysis framework. A comprehensive search of PubMed, OVID, Cochrane-CENTRAL, EMBASE, Scopus, and Web of Science was conducted, using relevant keywords. Dichotomous data on mortality and other clinical events were extracted and pooled as risk ratios (RRs), with their 95% confidence-interval (CI), using RevMan software (version 5.3). Twelve studies (8451 patients) were pooled in the final analysis. The overall effect-estimate did not favor rate or rhythm control strategies in terms of all-cause mortality (RR= 1.13, 95% CI [0.88, 1.45]), stroke (RR= 0.97, 95% CI [0.79, 1.20]), thromboembolism (RR= 1.06, 95% CI [0.64, 1.76]), and major bleeding (RR= 1.10, 95% CI [0.90, 1.35]) rates. These findings were consistent in AF patients with concomitant heart failure (HF). The rate of rehospitalization was significantly higher (RR= 0.72, 95% CI [0.57, 0.92]) in the rhythm control group, compared to the rate control group. In younger patients (<65 years), rhythm control was superior to rate control in terms of lowering the risk of all-cause mortality (p=0.0003), HF (p=0.003) and major bleeding (p=0.02). In older AF patients and those with concomitant HF, both rate and rhythm control strategies have similar rates of mortality and major clinical outcomes; therefore, choosing an appropriate strategy should consider individual variations, such as patient preferences, comorbidities, and treatment cost.

Keywords: Atrial Fibrillation; Meta-analysis; Rate Control; Rhythm Control

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