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Cardiologists Spot Best Treatment for a Deadly Duo
Date:6/18/2008

iod 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.

So, all things being equal, rate control should be the primary approach, Roy concluded, since antiarrythmic drugs are tougher on patients. "We know they can be successful, but they have many side effects, particularly in patients with heart failure," Roy said.

Making heart rate control first-line treatment in such cases "would reduce the number of hospitalizations, reduce the number of procedures, and the major outcomes would be the same," he said.

But the concept of rhythm control need not be abandoned, stressed Dr. Michael E. Cain, dean of the University at Buffalo School of Medical and Biomedical Sciences, and co-author of an accompanying editorial.

"One of the points we tried to make [in the editorial] is that we don't know if the concept is wrong, or we just don't have the optimal therapy to attain nature's rhythm," Cain said. "We can't prove it, because the existing therapies are not good enough to ensure that if you put someone on antiarrythmic therapy, it will be a normal rhythm and will not have severe side effects."

So, until that question is cleared up, "let's use a therapy [such as rate control] that works better and has less side effects, and see which works better," Cain said.

Another paper in the same issue of the journal announced discouraging news in the effort to develop a better antiarrythmic drug. An earlier report on the first trials for the drug, called dronedarone, noted that preliminary results did look promising. But the new study -- led by physicia
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