Purpose: The purpose of this article is to review the optimal heart rate goal in patients with atrial fibrillation with rapid ventricular response and heart failure.
Method: A PubMed literature search was conducted with search terms “lenient versus strict rate control”, “atrial fibrillation”, “heart failure”, and “rate control”.
Results: There is a lack of evidence-based research on optimal heart rate goals in patients with atrial fibrillation with rapid ventricular response and heart failure. Studies that were performed did not come to a consensus and so there is no firm guideline in treating these patients. One study supported strict rate control to decrease mortality and another supported lenient rate control. Other studies showed no correlation between heart rate control and mortality.
Conclusion: In patients with atrial fibrillation, lenient heart rate control has been found to be non-inferior to strict rate control in the RACE (Rate Control Efficacy in Permanent Atrial Fibrillation: A Comparison between Lenient versus Strict Rate Control) II trial. There have been few studies evaluating optimal heart rate control in patients with atrial fibrillation with rapid ventricular response and heart failure. There appears to be no effect on mortality with either strict or lenient control of heart rate in these patients, regardless of ejection fraction status. The studies that favored one or the other had explainable conditions.
Keywords: lenient versus strict rate control, rate control, atrial fibrillation, heart failure
Chi TQ. Lenient Rate Control Versus Strict Control of Atrial Fibrillation in the Setting of Heart Failure. Lynchburg Journal of Medical Science. 2021; 4(1).
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