Functional status with rhythm versus rate control strategies for persistent atrial fibrillation.

Introduction Recent studies have demonstrated that rhythm does not provide additional benefit over rate-control in terms of morbidity or mortality, and is less cost effective, in patients with atrial fibrillation (AF). It remains to be determined if either treatment strategy should be favored on the basis of the quality of life (QoL) and/or functional capacity. Objectives This HOT CAFE substudy was conducted to compare the functional status of patients with persistent AF assigned either rate or rhythm-control strategy. Patients and methods We enrolled 205 patients (mean [SD] age, 60.8 [11.2] years) with persistent AF who were randomly assigned either rate or rhythm-control strategies. NYHA functional classification (NYHA-FC), arrhythmia related symptoms intensity, exercise tolerance and QoL were analyzed. Results After a mean of 1.7 [0.4] years, the NYHA-FC and QoL improved over time in both groups. Both strategies lead to improvement in AF related symptoms. Treadmill test duration and maximal workload increased over time in both groups. In terms of NYHA-FC improvement rhythm-control was superior in patients with AF and hypertension (RR 1.89; 95%CI: 0.98-3.65; p<0.05) or moderate HF (RR 2.04; 95%CI: 1.03-4.06; p<0.04). When success was considered as LV function the rhythm-control strategy similarly proved to be superior in hypertensives (RR 2.63; 95% CI: 0.93-5.45; p<0.05) and those with NYHA II/III class (RR 2.63; 95%CI: 0.93-5.45; p<0.05). Conclusions Rate and rhythm-control strategies improved functional status in patients with persistent AF. However rhythm control might be appropriate for patients with AF and hypertension and moderate HF.