The effect of rate versus rhythm control strategy on the left ventricular function in patients with persistent atrial fibrillation: results of one year follow-up

Abstract

Background: Patients with persistent atrial fibrillation (AF) can be managed with either rhythm or rate control strategy. The restoration and maintenance of the sinus rhythm is not superior to the rate control regarding the total mortality and the rate of thromboembolic complications. Data concerning the effect of these strategies on left ventricular morphology and function is missing. The objective of our prospective randomised multicenter study in patients with persistent AF was to evaluate the effect of these two approaches on left ventricular morphology and function.
Methods and Results: The study group consisted of 205 patients (F/M 71/134; mean age 60.8 ± 11.2 years), including 101 patients randomized to the rate control approach (Group I) and 104 patients randomized to sinus rhythm (SR) restoration with DC cardioversion and subsequent antiarrhythmic drug treatment (Group II). Mean duration of AF was 231.8 ± 112.4 days. At the end of follow-up (12 months), SR was present in 64% of patients in Group II. Echocardiographic examination was performed at a baseline and at 2 and 12 months. The comparison of the left ventricular end-diastolic diameter revealed no difference within and between groups (50.8 ± 5.6 mm vs. 52.2 mm ± 6.8 mm at a baseline and 50.0 ± 6.0 vs. 52.0 ± 7.4 mm at 12 months, respectively). Overall, the fractional shortening of the left ventricle increased during the follow-up. Thus, the initial significant difference between groups (32.8 ± 6.6% vs. 29.9 ± 6.9%, p < 0.005) became insignificant at 12 months (35.6 ± 7.4% vs. 31.3 ± 7.3%).
Conclusions: We found no significant difference regarding the left ventricular morphology and function between the rate and rhythm control strategies in patients with persistent AF.