Rate control in atrial fibrillation

PhD ceremony: Mr. H.F. Groenveld, 12.45 uur, Academiegebouw, Broerstraat 5, Groningen

Dissertation: Rate control in atrial fibrillation

Promotor(s): prof. I.C. van Gelder, prof. M.P. van den Berg, prof. D.J. van Veldhuisen

Faculty: Medical Sciences

Atrial fibrillation is the most common type of arrhythmia. Many patients have permanent atrial fibrillation. One of the treatment aims for patients with permanent atrial fibrillation is a low heart rate, but this goal is not evidence based. We performed a comparative study on the prognosis of patients who were treated according to a strict, or a lenient rate control. Strict rate control was defined as a resting heart rate <80 beats/minute and <110 beats/minute during moderate exercise. Lenient rate control was defined as a resting heart rate <110 beats/minute. Prognosis was defined by cardiovascular death, hospitalization for heart failure, stroke, bleeding, life threatening arrhythmias, and pacemaker or defibrillator implantations. In the lenient rate control group 97% of patients was treated according to protocol, in the strict group 67%. There was no difference in prognosis between patients treated according to a lenient or strict rate control strategy. In addition, there was no difference in outcome between patients with lenient, successful strict, and failed strict rate control. There was no difference in quality of life between lenient and strict rate control at the end of the study. Heart rate did not influence quality of life. In conclusion, patients with permanent atrial fibrillation can be treated according to a lenient rate control strategy. This will result in less medication, and less frequent hospital visits. It simplifies the treatment of permanent atrial fibrillation for the patient and the physician.