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Title: Rhythm vs. rate control of atrial fibrillation meta-­‐analysed by number needed to treat. Name: Dustin Palm
Plain Language Summary:
There are four chambers in the heart. To work best, chambers work together in
synchrony. They do this by communicating in a predictable way. Atrial fibrillation (AF)
is a condition of the heart. It messes with normal communication between chambers. The
communication in the heart is unpredictable in AF. This prevents the heart from working
properly. This can cause clots to form. If the clots get out of the heart, they can cause
damage to other parts of your body. If this happens to the brain, we call it a stroke. AF
increases the risk of stroke and death. AF can also cause a fast heart. This is called AF
with rapid ventricular response. This can produce symptoms. It can cause sweating,
dizziness, syncope and heart attack. There are two things we can do to treat AF.
1. Rhythm control: we can restore the normal communication pathway in the heart.
This is called cardioversion. We can do this with medicine or with a procedure.
The medicines are called antiarrhythmic drugs. The procedure involves resetting
the heart with electricity. If we use the rhythm method, you would be encouraged
to take medicine to prevent clots from forming.
2. Rate control: we can prevent the heart from beating fast with medicines. In this
case, we would also need to start another medication to prevent clots from
forming. We call these medicines blood thinners. Therapy with blood thinners is
called anticoagulation. If we use the rate method, we would need to anticoagulate
you from now on with more medicine. You would have to take these medicines as
long as you still have AF.
In the past we thought rhythm control was better. Now we are not sure. There is no good
evidence that rhythm control is better than rate control. A recent study found no evidence
that rhythm control decreased death, stroke or other complications compared to rate
control. In addition, if we choose rhythm control, you may be more likely to be
hospitalized later on. Medicines used in rhythm control can have serious side effects. You
are more likely to have adverse reactions to these medicines than rate control
medications. There is no difference between quality of life in those that use rhythm
control versus those that use rate control to treat their AF.
Rate control medications also have side effects. They can cause slow heart rate, headache
and dizziness. But in general people tolerate these medications.
Whether we use rhythm control or rate control, you should be anticoagulated. By that we
mean take medications to prevent clots from forming. Whether you do rate or rhythm,
stopping these blood thinner medications will increase your risk of stroke and death.
Additional Resources: for additional information, please reference these trusted sites.
• www.medlineplus.gov
• www.uptodate.com/patients/
• www.fairview.org - Health Library tab
Key Words:
1. atrial fibrillation
2. arrhythmia
3. rhythm control
4. rate control
5. anticoagulation
This document was created by a medical student enrolled in the Family Medicine Clerkship at the
University of Minnesota Medical School as part of the course project. The aim of the project is to
present information on a medical topic in the format of a patient education handout. It does not
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