Rate vs. Rhythm Control controversy

[Guest guest]

Browsing through the 'web' today I was in Medscape/Medstudent

subsection and found another study concerning the above subject. It

is my feeling that most cardiologists today lean toward the rate

control method rather than the rhythm alternative, probably because

of the more harmful effects of antiarrhythmics than anything else.

But as a sufferer of this condition I feel they are forgetting the

very important factor of Quality of Life in their treatments.

Below is a direct copy of the last few paragraphs of a study with

only a relatively small number of patients,(375), for roughly 3

years, but it addresses the QOL factor more openly.

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The authors concluded that treatment strategy did not have a

significant effect on QOL because SR was only maintained in a

minority of patients during long-term follow-up; for instance, only

39% of rhythm-control patients were in SR at study end. The authors

contend that the observed improvements in both physical and mental

health scales indicate that " SR may improve exercise tolerance and a

sense of vitality. Thus, rhythm control may be beneficial in

improving QOL if effective. " They go on to state that identifying a

better means to achieve long-term SR may have a " major general impact

on QOL in patients with persistent AF. "

According to Dr. Hagens and colleagues, the slight changes at 12-

month follow-up observed in rate- and rhythm-control

patients " indicate that treatment of AF in a study like this, with

relatively frequent visits, may improve QOL in the short term,

possibly due to treatment effects, irrespective of the kind of

therapy. However, during long-term follow-up these improvements

largely vanish. "

" Although rate control is not inferior to rhythm control, with regard

to morbidity and mortality (AFFIRM and RACE), long-term SR by a

rhythm-control approach may be preferable for improvement of

subjective general well-being, " the authors concluded.

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I am only one patient with this malady, but when I'm in NSR I feel so

good I could jump for joy. When I'm in Afib and my rate is at an

acceptable level I can still function, but I certainly don't feel as

alive and well as before. I vote for rhythm control over rate

control anytime.

S.

[Guest guest]

(SNIP)

> I am only one patient with this malady, but when I'm in NSR I feel

so

> good I could jump for joy. When I'm in Afib and my rate is at an

> acceptable level I can still function, but I certainly don't feel

as

> alive and well as before. I vote for rhythm control over rate

> control anytime.

>

> S.

**************************************************************

- I agree with you wholeheartedly on the preference for nsr over

rate controlled afib (myearlier state) or aflutter (my current

state). But it seems to me the operative comment in the study

is " Thus, rhythm control may be beneficial in improving QOL if

effective. " I focused on the " if effective " and their 39% success

rate at their long term follow up. Worth the risk still, IF there

are no significant side effects. But there are significant side

effects to most if not all of the rhythm control drugs, from what I

can tell from reading this forum. So for me, it will be study,

study, study, then probably flip a coin. Makes an ablation look like

an increasingly attractive alternative.

Ed in VA

[Guest guest]

--- In AFIBsupport , " traveler3406 " <esmock@c...> >

to most if not all of the rhythm control drugs, from what I

> can tell from reading this forum. So for me, it will be study,

> study, study, then probably flip a coin. Makes an ablation look

like

> an increasingly attractive alternative.

> Ed in VA

Unfortunately, with ablation sucess rates at an average of only

around 50% I think I'll wait a few years until it's (hopefully)

better perfected and some long term studies have been done. For now

Flecainide is doing a nice job of keeping me in nsr.

[Guest guest]

:

IMHO, the success rates for PVA's is directly tied to the experience & expertise

of the EP who does the procedure. Many of the experienced clinics are doing much

better than 50% you mentioned. The Cleveland Clinic quotes success rates of 85%

for the first PVA, & 95% if a " touchup " PVA is required. I'm not familiar with

the percentages at other major AF centers, but I would guess they are in the

same range. I was advised by a local EP that his success rate was 50%. Seems to

me that is the question to ask of any EP you might be considering for a PVA.

There are a lot of EP's nationwide that are doing better than 50%. I certainly

wouldn't disagree with your logic of waiting since your rhythm control is

working for you. I also agree that success rates will go up for PVA's as time

goes by, and no doubt the technique will just get better & better. That said,

since PVA's preformed right now have a very high chance for success, for a lot

of us it seems like a good call. In my case, because I was chronic AF, all the

information I found indicated that the longer I waited for a PVA, the less

chance of a successful outcome because of the remodeling the heart goes through

in chronic AF.

Thor

Re: Rate vs. Rhythm Control controversy

--- In AFIBsupport , " traveler3406 " <esmock@c...> >

to most if not all of the rhythm control drugs, from what I

> can tell from reading this forum. So for me, it will be study,

> study, study, then probably flip a coin. Makes an ablation look

like

> an increasingly attractive alternative.

> Ed in VA

Unfortunately, with ablation sucess rates at an average of only

around 50% I think I'll wait a few years until it's (hopefully)

better perfected and some long term studies have been done. For now

Flecainide is doing a nice job of keeping me in nsr.

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[Guest guest]

In my case, because I was chronic AF, all the information I found

indicated that the longer I waited for a PVA, the less chance of a

successful outcome because of the remodeling the heart goes through

in chronic AF.

> Thor

Thor - Thanks for the additional info on success rates. By the way,

how are you doing?

Ed in VA