Download Factsheet - Rate vs Rhythm Management (160201)

AF A
AF Association
PO Box 6219
Shipston-on-Stour
CV37 1NL
+44 (0) 1789 867 502
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www.afa.org.uk
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www.afa.org.uk
Rate versus rhythm management
This factsheet explains the difference between
managing the heart rate and treating the heart
rhythm of patients with AF.
Patients who suffer from AF may have physical
symptoms of palpitations, breathlessness,
lethargy or loss of exercise tolerance (tiredness
at an earlier point of activity) or they may have
no symptoms at all. Symptoms may be caused by
the high heart rate that some people experience
during AF or as a result of the AF itself. Symptoms
of AF or indeed the amount of AF that people
have does not predict risk of stroke. Please see
the AF Association booklet ‘Preventing AF-related
stroke:Anticoagulation’ for more information.
However, symptoms will determine choices in the
ongoing
. management of AF.
Although it would seem logical that if a patient
is returned to their normal sinus rhythm the risk
of stroke would return to normal, but this has
not yet been proved to be the case by evidence
from studies. This risk (which is small in young
people with normal hearts) would seem to remain
regardless of the rhythm or symptoms, perhaps
because patients get AF that they or their doctor
are unaware of. Therefore, the only benefit with
rhythm control that we are currently aware of is
improvement in quality of life for those patients
experiencing troublesome symptoms from AF.
Many patients who have no symptoms may
therefore opt for heart rate control because it is
the simplest and safest strategy. On the other
hand, those patients who continue to have
symptoms despite having good heart rate control
may decide that they want heart rhythm control
because for them the risks (which are still small)
are outweighed by the benefits that rhythm
control brings (i.e. relief of symptoms).
For heart rate control, treatment is usually with
medications like beta blockers or calcium channel
blockers. For heart rhythm control, the options
are:
a) pill-in-the-pocket (taking a combination of rate
and rhythm control medication when symptoms
occur)
b) regular medication (taking rate and rhythm
controlling medication regularly)
c) catheter or surgical ablation
Details of these and other treatments can be
found in other AF Association information
factsheets.
Acknowledgements: Particular thanks are given to Professor
Richard Schilling (Professor of Cardiology and Electrophysiology),
Dr Matt Fay (GPwSI), and Jayne Mudd (Arrhythmia Nurse Lead).
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www.aa-international.org
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Founder & Chief Executive: Trudie Lobban MBE Trustees: Professor A John Camm,
Professor Richard Schilling, Mrs Jayne Mudd and Dr Matthew Fay
Registered Charity No. 1122442
© AF-A Published February 2009, reviewed October 2014, Planned review date November 2018
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Please remember that this publication provides general guidelines only. Individuals should always discuss their condition
with a healthcare professional. If you would like further information or would like to provide feedback please contact AF Association.
Rate versus rhythm management - Patient information
In patients who suffer with atrial fibrillation (AF)
there is a question as to whether it would be in
their best interests to be looked after in the new
stable rhythm of AF or more appropriate to try
to return the heart to its normal ‘sinus’ rhythm.
This question is termed ‘Rate versus rhythm
management ’.
Furthermore, the treatments used for rhythm
control (both medications and operations)
are more complex and therefore associated
with slightly higher risk than rate control
treatments. Therefore patients will need enough
understanding of the treatment options for
rhythm control to decide whether their symptoms
justify the treatment.