Lenient versus strict rate control in atrial fibrillation.

At the turn of the century, a spate of randomized, controlled trials (RCTs) compared the 2 main pharmacological options for rhythm management for atrial fibrillation (AF): repeated attempts to restore and maintain sinus rhythm (rhythm control) and controlling the heart rate without any specific attempts to restore and maintain sinus rhythm (rate control) (1). Largely driven by results of the 2 largest studies (2,3), these RCTs showed little or no advantage with rhythm control. If anything, there was a trend for an advantage with rate control with respect to death, stroke, and cost (1,4). imilar “no difference” results were noted later for AF atients with congestive heart failure and reduced systolic unction (5). A plethora of studies of various aspects of rate ontrol should have followed such results. With the excepion of RACE II (RAte Control Efficacy in permanent trial fibrillation II), that has not happened.