Rhythm control or rate control?

AFFIRM - no survival benefit between rhythm vs rate. Rhythm towards in mortality

AF-CHF - no reduction of mortality in patients with HFrEF

HOT CAFÉ – No sig survival benefits

EAST-AFNET 4

Early Rhythm-Control Therapy in Patients with Atrial Fibrillation

Early rhythm-control therapy was associated with a lower risk of cardiovascular outcomes than usual care among patients with early atrial fibrillation and cardiovascular conditions.

Target heart rate?

RACE II - strict rate control(<80) vs lenient rate control(<110). similar outcome.

Warfarin or antiplatelets?

SPAF

In patients with AF aspirin alone and warfarin alone both reduce stroke risk.

Warfarin is better.

ACTIVE W

ASA+Clopidogrel is inferior to warfarin

• ‰%z does

ACTIVE A

ASA+Clopidogrel is better than ASA alone for patients with contraindications for warfarin