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. 2024 Jul 25;10(15):e35218.
doi: 10.1016/j.heliyon.2024.e35218. eCollection 2024 Aug 15.

Rate control or rhythm control in patients with atrial fibrillation and acute coronary syndrome or percutaneous coronary intervention

Jing-Yang Wang  1 , Ran Mo  2 , Jun Zhu  1 , Jiang-Shan Tan  1 , Lu-Lu Wang  1 , Wei Xu  1 , Juan Wang  1 , Shuang Wu  1 , Si-Qi Lyu  1 , Han Zhang  1 , Yan-Min Yang  1
Affiliations

Rate control or rhythm control in patients with atrial fibrillation and acute coronary syndrome or percutaneous coronary intervention

Jing-Yang Wang et al. Heliyon. .

Abstract

Background: Restoring and maintaining sinus rhythm in patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI) has been studied in clinical trials to reduce symptoms and improve quality of life. Limited data exist on the effectiveness of rate or rhythm control therapy in these patients.

Methods: Consecutive patients with AF and ACS or referred for PCI were prospectively recruited in Fuwai Hospital during 2017-2020. The primary endpoints were all-cause death and major adverse cardiovascular and cerebrovascular events (MACCEs), including cardiovascular mortality, myocardial infarction, ischemic stroke, non-central nervous system embolism and ischemia-driven revascularization. Kaplan-Meier curves and Cox regressions were performed to evaluate the association between rhythm/rate control and subsequent outcomes. For the primary endpoints, we used the Benjamini-Hochberg correction for multiple comparisons.

Results: A total of 1499 patients with AF and ACS or undergoing PCI were included, with a median follow-up of 34.7 months. Compared to non-rate control, rate control strategy reduced the risk of subsequent MACCEs (adjusted HR, 0.320; 95 % CI 0.220-0.466; p <0.001; *p <0.002) and all-cause death (adjusted HR, 0.148; 95 % CI 0.093-0.236; p <0.001; *p <0.002). Similar trends were observed across all predefined subgroups (p <0.001). In the final multivariate model, rhythm control was not associated with a lower subsequent MACCEs but significantly improved all-cause mortality compared to non-rhythm control (adjusted HR, 0.546; 95 % CI 0.313-0.951; p =0.033; *p =0.044).

Conclusions: In this real-world study, rate control strategy was associated with lower risk of MACCEs and all-cause death in AF and ACS or undergoing PCI. Besides, management with rhythm control strategy may improve all-cause mortality.

Keywords: Acute coronary syndrome; Atrial fibrillation; Rate control; Rhythm control.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
A, MACCEs with rhythm (rate) control in patients with AF who develop ACS or undergo PCI (ref = non-rhythm (rate) control); B, All-cause death with rhythm (rate) control in patients with AF who develop ACS or undergo PCI (ref = non-rhythm (rate) control). AF, atrial fibrillation; ACS, acute coronary syndrome; PCI, percutaneous coronary intervention; MACCEs, major adverse cardiovascular and cerebrovascular events.
Fig. 2
Fig. 2
A. Adjusted HRs of primary outcomes for AF patients with ACS or receiving PCI who treated with rhythm control (ref = non-rhythm control). B. Adjusted HRs of primary outcomes for AF patients with ACS or receiving PCI who treated with rate control (ref = non-rate control). AF, atrial fibrillation; ACS, acute coronary syndrome; PCI, percutaneous coronary intervention; HR, hazard ratio; MACCEs, major adverse cardiovascular and cerebrovascular events.
Fig. 3
Fig. 3
Forest plot of treatment effects of rate-control compared to non-rate control therapy by predefined subgroups.
Fig. 4
Fig. 4
Forest plot of treatment effects of rhythm-control compared to non-rhythm control therapy by predefined subgroups.
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