Rate-Control Treatment and Mortality in Atrial Fibrillation

In this AF cohort (n=101,243 on beta-blockers (BBs), calcium channel blockers (CCBs) or digoxin and 168,678 not on rate-control), risk of mortality during 4.9years follow-up was lower for patients on BBs or CCBs vs. no rate control. Digoxin use was linked to greater mortality.

An editorial provides some take home messages from these data and related research:

 

1. Rate control  in patients with AF is aimed at controlling ventricular heart rate. Lenient rate control can be a first choice strategy in patients with no or minor symptoms. A more strict rate control approach should be adopted when symptoms persist or deterioration of left ventricular function occur.

 

2. A second aim is to institute drugs that may improve outcome in AF patients. The present study adds to the overwhelming and often inconsistent data on beneficial or detrimental effects of the different rate controlling drugs.

 

3. Until data from RCTs are available the choice of rate control drugs should be individualised depending on age, lifestyle, associated comorbidities and heart rate.

 

4. Rate control drugs should be initiated carefully and dosages may be adjusted during the course of the disease as comorbidities and conduction disturbances may either develop or proceed.