{
  "abstract": "Background Preventing high heart rates in atrial fibrillation (AF) is recommended to reduce AF-related symptoms and morbidity. Evidence on a strong relationship between lower heart rate during AF and a reduction in symptoms or cardiovascular complications is, however, lacking.Methods This Early Treatment of Atrial Fibrillation for Stroke Prevention Trial analysis compared symptoms, treatment strategy and the composite of death from cardiovascular causes, stroke or hospitalisation with worsening of heart failure or acute coronary syndrome between patients with a heart rate <110 beats per minute and ≥110 beats per minute at baseline.Results At baseline, 772 patients were in AF and had information on heart rate available. Mean age was 70.8±7.8 years, 305 (40%) were women, 385 (50%) were randomised to early rhythm control and 506 (66%) patients had a heart rate <110 beats per minute. Patients with a heart rate ≥110 beats per minute at baseline were more likely to have symptomatic AF (78% vs 62%, p<0.001) and more likely to have severe symptomatic AF with a European Heart Rhythm Association score ≥3 (19% vs 12%, p=0.032). The primary outcome, a composite of death from cardiovascular causes, stroke or hospitalisation with worsening of heart failure or acute coronary syndrome, occurred in 116 patients with a heart rate <110 beats per minute (5.1 per 100 person-years) and 62 patients with a heart rate ≥110 beats per minute (5.1 per 100 person years). The HR of the primary outcome for patients with a heart rate ≥110 beats per minute compared with patients with a heart rate <110 beats per minute was 1.08 (95% CI 0.79 to 1.48).Conclusion A high heart rate (≥110 beats per minute) during AF is associated with more and more severe AF-related symptoms. Cardiovascular event rates are not different between heart rates. Early rhythm control reduces outcomes in patients with high and low heart rates during AF.Trial registration number NCT01288352.",
  "authors": [
    {
      "affiliations": [
        "Department of Cardiology, Martini Hospital, Groningen, The Netherlands",
        "Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands"
      ],
      "name": "Tim Koldenhof"
    },
    {
      "affiliations": [
        "University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany"
      ],
      "name": "Katrin Borof"
    },
    {
      "affiliations": [
        "Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands"
      ],
      "name": "Isabelle C Van Gelder"
    },
    {
      "affiliations": [
        "Department of Cardiology, Martini Hospital, Groningen, The Netherlands"
      ],
      "name": "Robert G Tieleman"
    },
    {
      "affiliations": [
        "Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany"
      ],
      "name": "Marc D Lemoine"
    },
    {
      "affiliations": [
        "Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany",
        "Cardiology, University Heart Center Hamburg, Hamburg, Germany"
      ],
      "name": "Renate B Schnabel"
    },
    {
      "affiliations": [
        "Department of Medical Biometry and Epidemiology, University Medical Center Hamburg, Hamburg, Germany"
      ],
      "name": "Karl Wegscheider"
    },
    {
      "affiliations": [
        "Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany",
        "Centre for Cardiovascular Sciences, University of Birmingham, Birmingham, UK"
      ],
      "name": "Paulus Kirchhof"
    },
    {
      "affiliations": [
        "Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands"
      ],
      "name": "Michiel Rienstra"
    },
    {
      "affiliations": [],
      "name": "for the EAST-AFNET 4 Trial Investigators"
    }
  ],
  "title": "Heart rate in early rhythm control therapy in patients with atrial fibrillation",
  "uid": "184b1a50-bb21-5c4d-bd59-f777d7731e5a"
}