Table 2 Risks and benefits of rate control versus rhythm control
From: Clinical review: Clinical management of atrial fibrillation – rate control versus rhythm control
Rhythm control | Rate control | ||
|---|---|---|---|
Benefits | Risks | Benefits | Risks |
Relief of symptoms | Poor efficacy of antiarrhythmic drugs in maintaining sinus rhythm | Efficacious agents in maintaining rate control | Need for continuing anticoagulation with associated risks |
Improved exercise tolerance | |||
Less need for anticoagulation therapy | Greater rates of adverse effects of antiarrhythmic drugs (including death) | Relief of symptoms (quality of life scores) not significantly different compared with rhythm control | Rhythm control may not be an option for a first presentation of uncontrolled rate |
Improved haemodynamic function | Major cardiovascular events may be more common in rhythm control (especially if other risk factors are present) | Stroke risk no different to maintaining rhythm control | |
Prevention of tachycardia-induced cardiomyopathy | Greater rates of hospitalization compared with rate control | Overall mortality no different to rhythm control | |
Greater cost-effectiveness of rate control compared with rhythm control | |||