Difference in benefits between rhythm therapy and heart rate therapy for atrial fibrillation:a Meta-analysis

Wang Zhaobo; Li Yingying; Lin Qian

doi:10.3969/j.issn.1674-4055.2024.01.05

Abstract：Objective To review the combined benefits of rhythm therapy and heart rate(HR)therapy for atrial fibrillation(AF)through a Meta-analysis.Methods The databases of Cochrane Central Register of Controlled Trials,Embase,PMC and Web of Science were retrieved for screening randomized controlled trials(RCT),and effects,sensitivity,heterogeneity and publication bias were reviewed by using STATA 15.0 software.Results A total of 22 RCT with 42,037 participants were included in the study.The primary endpoint events were less in rhythm therapy group compared with HR therapy group,which was more significantly with increasing time.The results of 5-y follow-up showed that long-term survival rate had no significant difference between 2 groups.The improvement of left ventricular ejection fractions(LVEF,SMD=-0.40,95%CI:-0.68～-0.13,P=0.004),metabolic equivalents(METs,SMD=-0.42,95%CI:-0.76～-0.08,P=0.016),exercise tolerance time(SMD=-0.71,95%CI:-0.76～-0.49,P=0.000)and scores of quality of life(QOL,SMD=-0.92,95%CI:-1.76,-0.07,P=0.034)were more significant,and ischemic stroke(OR=0.85,95%CI:0.78,0.94,P=0.016)was less in rhythm therapy group.The differences in left atrial diameter(LAD),left ventricular end-diastolic dimension(LVEDD)and embolism events were not significant between 2 groups.Conclusion Restoration of sinus rhythm can significantly improve heart function and QOL,and the combined benefit of rhythm control is more significant in long-term treatment.Heart rate control has long been considered a viable compromise option,but rhythm therapy will undoubtedly be the broader development.This Meta-analysis recommends more aggressive rhythm therapy compared to previous guidelines.