Early rhythm control vs. rate control in atrial fibrillation: A systematic review and meta-analysis
ObjectiveIt has long been debated whether rhythm control vs. rate control strategies have differing effects on mortality and morbidity for atrial fibrillation (AF). Recently, several randomized controlled studies (RCTs) and observational trials described that an early rhythm management method was li...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-02-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.978637/full |
| _version_ | 1811170951560167424 |
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| author | Shaojie Han Ruikun Jia Zhifu Cen Ran Guo Shenyu Zhao Yixuan Bai Min Xie Kaijun Cui |
| author_facet | Shaojie Han Ruikun Jia Zhifu Cen Ran Guo Shenyu Zhao Yixuan Bai Min Xie Kaijun Cui |
| author_sort | Shaojie Han |
| collection | DOAJ |
| description | ObjectiveIt has long been debated whether rhythm control vs. rate control strategies have differing effects on mortality and morbidity for atrial fibrillation (AF). Recently, several randomized controlled studies (RCTs) and observational trials described that an early rhythm management method was linked to a lower likelihood of negative clinical outcomes in individuals with AF. We wanted to see if an early rhythm management method may help patients with AF.MethodsWe performed a systematic search to retrieve studies assessing the outcomes of early rhythm control vs. rate control in AF by using PubMed, Web of Science, Cochrane Library, and Embase published between 01/01/2000 and 15/04/2022.ResultsFinally, two RCTs, one retrospective analysis of RCTs, and four observational studies were identified. Compared with rate control, early rhythm control has been linked to lower all-cause mortality. [risk ratio (RR), 0.76; 95% CI 0.69–0.83; P < 0.00001; I2 = 77%]. The early rhythm control group was also associated with a lower risk of cardiovascular mortality (RR, 0.68; 95% CI 0.63–0.74; P < 0.00001; I2 = 33), stroke (RR, 0.77; 95% CI 0.67–0.87; P < 0.001; I2 = 64), and heart failure hospitalization (RR, 0.74; 95% CI 0.59–0.93; P = 0.0009; I2 = 93%). We found no significant difference in nights spent in hospital per year, acute coronary syndrome, major bleeding, and cardiac arrest/ventricular arrhythmia between the groups.ConclusionIn this meta-analysis, early rhythm therapy was linked to a lower risk of all-cause mortality, cardiovascular mortality, stroke, and heart failure hospitalization compared with the rate control group.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022333592. |
| first_indexed | 2024-04-10T17:06:20Z |
| format | Article |
| id | doaj.art-825828439a4249f7b2a8e5e10a41b88a |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-10T17:06:20Z |
| publishDate | 2023-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-825828439a4249f7b2a8e5e10a41b88a2023-02-06T05:07:52ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-02-011010.3389/fcvm.2023.978637978637Early rhythm control vs. rate control in atrial fibrillation: A systematic review and meta-analysisShaojie Han0Ruikun Jia1Zhifu Cen2Ran Guo3Shenyu Zhao4Yixuan Bai5Min Xie6Kaijun Cui7Department of Cardiology, West China Hospital, Sichuan University, Chengdu, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu, ChinaDepartment of Cardiology, Chengdu Seventh People’s Hospital, Chengdu, Sichuan, ChinaDepartment of Cardiology, West China Hospital, Sichuan University, Chengdu, ChinaObjectiveIt has long been debated whether rhythm control vs. rate control strategies have differing effects on mortality and morbidity for atrial fibrillation (AF). Recently, several randomized controlled studies (RCTs) and observational trials described that an early rhythm management method was linked to a lower likelihood of negative clinical outcomes in individuals with AF. We wanted to see if an early rhythm management method may help patients with AF.MethodsWe performed a systematic search to retrieve studies assessing the outcomes of early rhythm control vs. rate control in AF by using PubMed, Web of Science, Cochrane Library, and Embase published between 01/01/2000 and 15/04/2022.ResultsFinally, two RCTs, one retrospective analysis of RCTs, and four observational studies were identified. Compared with rate control, early rhythm control has been linked to lower all-cause mortality. [risk ratio (RR), 0.76; 95% CI 0.69–0.83; P < 0.00001; I2 = 77%]. The early rhythm control group was also associated with a lower risk of cardiovascular mortality (RR, 0.68; 95% CI 0.63–0.74; P < 0.00001; I2 = 33), stroke (RR, 0.77; 95% CI 0.67–0.87; P < 0.001; I2 = 64), and heart failure hospitalization (RR, 0.74; 95% CI 0.59–0.93; P = 0.0009; I2 = 93%). We found no significant difference in nights spent in hospital per year, acute coronary syndrome, major bleeding, and cardiac arrest/ventricular arrhythmia between the groups.ConclusionIn this meta-analysis, early rhythm therapy was linked to a lower risk of all-cause mortality, cardiovascular mortality, stroke, and heart failure hospitalization compared with the rate control group.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022333592.https://www.frontiersin.org/articles/10.3389/fcvm.2023.978637/fullatrial fibrillationearly rhythm controlrate controlmeta-analysiscardiovascular outcome |
| spellingShingle | Shaojie Han Ruikun Jia Zhifu Cen Ran Guo Shenyu Zhao Yixuan Bai Min Xie Kaijun Cui Early rhythm control vs. rate control in atrial fibrillation: A systematic review and meta-analysis Frontiers in Cardiovascular Medicine atrial fibrillation early rhythm control rate control meta-analysis cardiovascular outcome |
| title | Early rhythm control vs. rate control in atrial fibrillation: A systematic review and meta-analysis |
| title_full | Early rhythm control vs. rate control in atrial fibrillation: A systematic review and meta-analysis |
| title_fullStr | Early rhythm control vs. rate control in atrial fibrillation: A systematic review and meta-analysis |
| title_full_unstemmed | Early rhythm control vs. rate control in atrial fibrillation: A systematic review and meta-analysis |
| title_short | Early rhythm control vs. rate control in atrial fibrillation: A systematic review and meta-analysis |
| title_sort | early rhythm control vs rate control in atrial fibrillation a systematic review and meta analysis |
| topic | atrial fibrillation early rhythm control rate control meta-analysis cardiovascular outcome |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.978637/full |
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