Cardiologists Spot Best Treatment for a Deadly Duo

By Ed Edelson
HealthDay Reporter
Thursday, June 19, 2008; 3:00 AM

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WEDNESDAY, June 18 (HealthDay News) -- When added to heart failure, the irregular heartbeat called atrial fibrillation can form a deadly combination.

Now, an international study shows that a less onerous strategy called "rate control" may be the best first option for keeping patients healthy under these circumstances.

"Our results show that one strategy was not superior to the other in terms of major endpoints such as cardiovascular mortality," explained the study's lead author, Dr. Denis Roy, chair of medicine at the University of Montreal, Canada. That indicates that rate control should be the primary approach, Roy said.

"If patients on rate control do not feel well, then the physician can switch to the other approach," he said.

The findings are published in the June 19 issue of the New England Journal of Medicine.

An estimated 4.8 million Americans have heart failure, which involves a progressive loss of the heart's ability to pump blood. About 20 percent of these patients also have atrial fibrillation, an abnormal function of the upper chambers of the heart, Roy said.

Cardiologists have long been divided in their choice of treatments for the combination, Roy said. Some prefer to control the heart's rhythm, first by delivering a shock, then by prescribing powerful antiarrythmic drugs, notably amiodarone. Others prefer to use less potent drugs such as beta blockers to reduce the heart's rate, which can reach 140 to 150 beats per minute.

The trial, conducted at centers in seven countries, including the United States and Canada, enrolled almost 1,400 people affected by both atrial fibrillation and heart failure. Half had treatment aimed at controlling the heart's rhythm control, the other got therapies focused on managing the heart's rate.

Over an average follow-up period of a little more than three years, the death rate from cardiovascular causes was near equal between the two groups -- 27 percent in the rhythm-control group and 25 percent in the rate-control group. The overall death rate was 32 percent in the rhythm-control group and 33 percent in the rate-control group. The rates of other adverse outcomes, such as stroke and worsening heart failure, were also almost identical in the two groups.