心房細動と心不全（AF-CHF）

Final data from the AF-CHF trial suggest that patients with atrial fibrillation and heart failure have comparable mortality regardless of treatment approach, control of heart rhythm or control of heart rate, according to a late-breaking clinical trial presentation at the annual meeting of the American Heart Association.

The Atrial Fibrillation and Congestive Heart Failure (AF-CHF) trial was a prospective, randomized, multicenter clinical trial with 1,376 patients at 123 sites in Canada, the United States, Brazil, Argentina, Europe, and Israel.

In the trial, patients randomized to heart rhythm control underwent electrical cardioversion combined with antiarrhythmic therapy, using amiodarone as the initial drug of choice, with sotalol or dofetilide in specific cases.  In heart rate control, patients received titrated doses of beta-blockers and digoxin or both and pacemaker therapy if needed.  Both groups received optimal heart failure management and anticoagulation.

Patients were followed for an average of 37 months.   Cardiovascular death (the primary endpoint of the trial) occurred in 26.7 percent of patients in the rhythm-control group compared with 25.2 percent of patients in the rate-control group.

Total mortality (31.8 percent versus 32.9 percent), strokes (2.6 percent versus 3.6 percent) and worsening heart failure events (27.6 percent versus 30.8 percent) were also similar between rhythm control and rate control.

We found that rhythm control does not improve mortality when compared to rate control,” said Denis Roy, MD, principal investigator and professor and chair in the department of medicine at the University of Montreal, Quebec, Canada.  “The results of the trial do not suggest that a strategy of rhythm control should be advocated for patients with atrial fibrillation and congestive heart failure.”