Mending the rhythm does not improve prognosis in patients with persistent atrial fibrillation: a subanalysis of the RACE study

Aims To compare outcome of AF patients with effective rhythm control with patients treated with rate control. Methods and results Out of the 266 AF patients randomized to rhythm control in the RACE study, 49 patients turned to long-term sinus rhythm and were continuously treated with oral anticoagulation. The incidence of the primary endpoint in these patients was compared to that in 178 patients out of the initial 256 rate-control patients of RACE who were in AF and using oral anticoagulation continuously. Baseline characteristics of both groups were not different. After a mean follow-up of 2.3 +/- 0.6 years, the primary endpoint (a composite of cardiovascular mortality, heart failure, thrombo-embolic complications (TECs), bleeding, serious adverse effects of antiarrhythmic drugs and pacemaker implants) was 22.4% in the rhythm-control group vs. 15.2% in the rate-control group. Multivariable regression analysis indicated coronary artery disease, heart failure, and digitalis as independent risk indicators of cardiovascular morbidity and mortality. Chronic sinus rhythm did not matter. Conclusion Among patients who remained on warfarin, those who mostly were maintained in sinus rhythm under a rhythm-control strategy did not have a superior prognosis compared to those who remained in AF under a rate-control strategy.