Abstract 11096: Impact of Rhythm versus Rate Control in Atrial Fibrillation on All-Cause Mortality, Hospitalization and Stroke: A Systematic Review and Meta-Analysis

Introduction: Many randomized controlled trials (RCTs) compared rate control vs rhythm control therapy in patients with atrial fibrillation (AF). In this study, we systematically reviewed these RCTs and performed a meta-analysis of the outcomes comparing the two therapies. Methods: We searched PubMed, Medline, EMBASE, and SCOPUS databases until April 30, 2022 for all RCTs investigating AF rate vs rhythm control. We used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) for constructing and reporting this review. We assigned I 2 >50% as an indicator of statistical heterogeneity among the RCTs. We analyzed all-cause mortality, stroke rate, heart failure (HF) hospitalization, and total hospitalization between the two groups. We estimated the risk ratios (RR) with a random-effects model using the Mantel-Haenszel technique and calculated the 95% confidence intervals (CI). A P-value <0.05 was considered significant. All analyses were performed using Review Manager 5.3. Results: Twenty-one RCTs comprising 11,547 patients (77% male) were included. Between the two therapy groups, there was no significant difference in all-cause mortality (RR 1.02 [0.90-1.16], P=0.75 ), HF hospitalization (RR 1.04 [0.83-1.32], P=0.72 ), or stroke rate (RR 1.15 [0.88-1.50], P=0.32 ). Nonetheless, rate control was associated with reduced total hospitalizations (RR 0.77 [0.64-0.94], P=0.01 ). (Figure 1) Conclusions: Atrial fibrillation rate control therapy has similar outcomes to rhythm control in terms of all-cause mortality, HF hospitalization, and stroke rates, but a lower rate of total hospitalizations. Findings are consistent with multiple prior studies showing noninferiority of rate control to rhythm control. Figure 1 - Forest plots highlighting the outcomes of both treatment strategies on AF: A) All-cause mortality, B) Heart failure hospitalization, C) Stroke, and D) Total hospitalization.