Abstract 18974: Rhythm Control with Catheter Ablation Improves Cardiomyopathy and Heart Failure Compared with Rate Control

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Umashankar Lakshmanadoss ◽  
Amrish Deshmukh ◽  
Gunjan Choudhary ◽  
Pramod Deshmukh
Keyword(s):  
Heart Failure ◽  
Catheter Ablation ◽  
Rate Control ◽  
Linear Regression Analysis ◽  
Rhythm Control ◽  
Control Group ◽  
Matched Group ◽  
Rate Controlled ◽  
Control Rhythm

Introduction: Role of rhythm control in addition to rate control, in patients with atrial fibrillation and heart failure reduced EF (HFrEF) is unknown. Objective: We sought to compare catheter ablation with rate control in patients with AF and HFrEF. Methods: Ninety patients with AF and LVEF < 40 % underwent pulmonary vein isolation with or without substrate modification. Follow-up included Holter monitoring and echocardiography at baseline, 3 months and at 6 months. A propensity-matched group of 80 patients with AF and LVEF <40% treated with rate control was used for comparison. Post-matching weighted linear regression analysis was used to compare outcomes. Results: At 6 months, 64% of patients who underwent ablation remained in sinus rhythm. Average heart rate (HR) was similar between groups at baseline and follow up. (79 ± 14.5 to 76 ± 7.7 in ablation group and 82.4 ±8.9 to 78.3 ± 8.8 in rate control group). LVEF significantly improved in patients who underwent ablation (30.9 ± 8.6 to 43.4 ±10.9) compared with no change in patients who were rate controlled (to 25.8 ±19.3 to 25.2 ±6.64) (p=2E-16). NHYA class improved from 2.26 ±0.44 to 1.62 ±0.64 with ablation compared to 2.4 ±0.5 to 2.24 ±0.44 with rate control but did not reach statistical significance. Patients who remained in AF after ablation had minimal change in LVEF and NHYA class. No procedural complications noted. Conclusions: In patients with AF, HFrEF, and adequate HR control, rhythm control by catheter ablation improved LVEF compared with a propensity matched group of patients treated with rate control. Rhythm control with catheter ablation may be considered in patients with AF and HF who are adequately rate controlled

3153Rate versus rhythm control and mortality in atrial fibrillation patients: a Danish nationwide cohort study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F Dalgaard ◽  
S Al-Khatib ◽  
J Pallisgaard ◽  
C Torp-Pedersen ◽  
T B Lindhardt ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Disease ◽  
Control Strategy ◽  
Rate Control ◽  
Channel Blocker ◽  
Rhythm Control ◽  
All Cause Mortality ◽  
Control Therapy

Abstract Background Treatment of AF patients with rate or rhythm drug therapy have shown no difference in mortality in clinical trials. However, the generalizability of these trials to real-world populations can be questioned. Purpose We aimed to investigate the all-cause and cardiovascular (CV) mortality risk in a nationwide AF cohort by treatment strategy (rate vs. rhythm) and by individual drug classes. Methods We queried the Danish nationwide registries from 2000 to 2015 to identify patients with AF. A rate control strategy included the use of one or more of the following medications: beta-blocker, digoxin, and a class-4 calcium channel blocker (CCB). A rhythm control strategy included the use of an anti-arrhythmic drug (amiodarone and class-1C). Primary outcome was all-cause mortality. Secondary outcome was CV mortality. Adjusted incidence rate ratios (IRR) were computed using Poisson regression with time-dependent covariates allowing patients to switch treatment during follow-up. Results Of 140,697 AF patients, 131,793 were on rate control therapy and n=8,904 were on rhythm control therapy. At baseline, patients on rhythm control therapy were younger (71 yrs [IQR: 62–78] vs 74 [65–82], p<0.001) more likely male (63.5% vs 51.7% p<0.001), had more prevalent heart failure (31.1% vs 19.4%, p<0.001) and ischemic heart disease (40.1% vs. 23.3%, p<0.001), and had more prior CV-related procedures; PCI (7.4% vs. 4.0% p<0.001) and CABG (15.0% vs. 2.3%, p<0.001). During a median follow up of 4.0 (IQR: 1.7–7.3) years, there were 64,653 (46.0%) deaths from any-cause, of which 27,025 (19.2%) were CVD deaths. After appropriate adjustments and compared to rate control therapy, we found a lower IRR of mortality and CV mortality in those treated with rhythm control therapy (IRR: 0.93 [95% CI: 0.90–0.97] and IRR 0.84 [95% CI: 0.79–0.90]). Compared with beta-blockers, digoxin was associated with increased risk of all-cause and CV mortality (IRR: 1.26 [95% CI: 1.24–1.29] and IRR: 1.32 [95% CI: 1.28–1.36]), so was amiodarone: IRR for all-cause mortality: 1.16 [95% CI: 1.11–1.21] and IRR for CV mortality: 1.12 [95% CI: 1.05–1.19]. Class-1C was associated with lower all-cause (0.43 [95% CI: 0.37–0.49]) and CV mortality (0.35 [95% CI: 0.28–0.44]). Figure 1. Models were adjusted for age, sex, ischemic heart disease, stroke, chronic obstructive pulmonary disease, chronic kidney disease, valvular atrial fibrillation, bleeding, diabetes, ablation, pacemaker, implantable cardioverter defibrillator, hypertension, heart failure, use of loop diuretics, calendar year, and time on treatment. Abbreviations; CCB; calcium channel blocker, PY; person years. Conclusions In a real-world AF cohort, we found that compared with rate control therapy, rhythm control therapy was associated with a lower risk of all-cause and CV mortality. The reduced mortality risk with rhythm therapy could reflect an appropriate patient selection. Acknowledgement/Funding The Danish Heart Foundation

Abstract P111: Sex Differences in Rate or Rhythm Control and Outcomes Among Elderly Patients With Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Vinita Subramanya ◽  
J'Neka S Claxton ◽  
Pamela L Lutsey ◽  
Richard MacLehose ◽  
Alanna M Chamberlain ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Elderly Patients ◽  
Major Bleeding ◽  
Rate Control ◽  
Treatment Strategy ◽  
Cox Regression ◽  
Rhythm Control ◽  
To Receive

Introduction: Women with atrial fibrillation (AF) experience greater symptomatology, worse quality of life, and have a higher risk of stroke as compared to men, but are less likely to receive rhythm control for the treatment of AF. Whether these differences exist in elderly patients with AF, and whether sex modifies the effectiveness of rhythm versus rate control therapy has not been assessed. Methods: We studied 135,850 men and 139,767 women 75 years or older diagnosed with AF in the MarketScan Medicare database between 2007-2015. Rate control was defined as use of rate control medication or atrioventricular node ablation. Rhythm control was defined by use of anti-arrhythmics, catheter ablation or cardioversion. Participants on both rate and rhythm were coded under rhythm control. We used multivariable logistic and Cox regression models to estimate 1) the association of sex and treatment strategy (within 30-day post AF diagnosis and entire follow-up) and, 2) the association of treatment strategy with incident heart failure, stroke and major bleeding. Results: Men were on average (SD) 82.5 (5.2) years old and women 83.8 (5.6) years, respectively. Women were less likely to receive rhythm control treatment as compared to men in the 30-day post AF diagnosis period (22% vs 27%), (OR 0.91, 95% CI 0.88, 0.94) and over the entire duration of follow-up (28% vs 32%) (HR 0.93, 95% CI 0.90, 0.96). Rhythm (vs. rate) control was associated with a higher risk of heart failure in women [HR 1.41, 95% CI 1.34, 1.49] than in men [HR, 1.21 95% CI 1.15, 1.28] (p for multiplicative interaction < 0.001, Table ). Sex did not modify associations between treatment and incident stroke or major bleeding events. Conclusion: Women aged 75 years and older were less likely to be prescribed rhythm control as compared to men, and experienced higher risk of heart failure than men when receiving rhythm (vs rate) control. Future studies will need to delve into the mechanisms underlying these differences.

Rhythm control for patients with atrial fibrillation complicated with heart failure in the contemporary era of catheter ablation: a stratified pooled analysis of randomized data

2019 ◽  
Vol 41 (30) ◽  
pp. 2863-2873 ◽  
Author(s):  
Shaojie Chen ◽  
Helmut Pürerfellner ◽  
Christian Meyer ◽  
Willem-Jan Acou ◽  
Alexandra Schratter ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Catheter Ablation ◽  
Control Strategy ◽  
Rate Control ◽  
Similar Rate ◽  
Rhythm Control ◽  
Thromboembolic Events ◽  
All Cause Mortality

Abstract Aims The optimal treatment for patients with atrial fibrillation (AF) and heart failure (HF) has been a subject of debate for years. We aimed to evaluate the efficacy and safety of rhythm control strategy in patients with AF complicated with HF regarding hard clinical endpoints. Methods and results Up-to-date randomized data comparing rhythm control using antiarrhythmic drugs (AADs) vs. rate control (Subset A) or rhythm control using catheter ablation vs. medical therapy (Subset B) in AF and HF patients were pooled. The primary outcomes were all-cause mortality, re-hospitalization, stroke, and thromboembolic events. A total of 11 studies involving 3598 patients were enrolled (Subset A: 2486; Subset B: 1112). As compared with medical rate control, the AADs rhythm control was associated with similar all-cause mortality [odds ratio (OR): 0.96, P = 0.65], significantly higher rate of re-hospitalization (OR: 1.25, P = 0.01), and similar rate of stroke and thromboembolic events (OR: 0.91, P = 0.76,); however, as compared with medical therapy, catheter ablation rhythm control was associated with significantly lower all-cause mortality (OR: 0.51, P = 0.0003), reduced re-hospitalization rate (OR: 0.44, P = 0.003), similar rate of stroke events (OR: 0.59, P = 0.27), greater improvement in left ventricular ejection fraction [weighted mean difference (WMD): 6.8%, P = 0.0004], lower arrhythmia recurrence (29.6% vs. 80.1%, OR: 0.04, P &lt; 0.00001), and greater improvement in quality of life (Minnesota Living with Heart Failure Questionnaire score) (WMD: −9.1, P = 0.007). Conclusion Catheter ablation as rhythm control strategy substantially improves survival rate, reduces re-hospitalization, increases the maintenance rate of sinus rhythm, contributes to preserve cardiac function, and improves quality of life for AF patients complicated with HF.

scholarly journals Atrial Fibrillation Ablation in Patients with Heart Failure: One Size Does Not Fit All

2018 ◽  
Vol 7 (2) ◽  
pp. 84 ◽  
Author(s):  
Rahul K Mukherjee ◽  
Steven E Williams ◽  
Mark D O’Neill ◽  
◽  
◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Rate Control ◽  
State Of The Art ◽  
Previous Treatment ◽  
Rhythm Control ◽  
Patient Specific ◽  
Limited Efficacy ◽  
Patients With Heart Failure

Atrial fibrillation (AF) is common in patients with heart failure and is associated with poorer clinical outcomes compared with patients with heart failure alone. Recent evidence has challenged previous treatment paradigms in which rate control was considered equivalent to rhythm control in this population. Catheter ablation has emerged as a safe and effective treatment strategy in selected patients and overcomes the issues of limited efficacy and drug toxicities associated with pharmacological rhythm control. Numerous studies have explored the benefits of catheter ablation in patients with heart failure, but these have included heterogeneous patient cohorts and variable ablation strategies. This state-of-the-art review explores the evidence from these trials and examines the need for tailored, patient-specific strategies for AF ablation in patients with heart failure.

Abstract 18172: Rhythm Control with Catheter Ablation Improves Ejection Fraction Compared to Rate Control: A Meta-Analysis of Randomized Controlled Studies

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ajay Vallakati ◽  
Arun Kanmantha Reddy ◽  
Mark Dunlap ◽  
William Lewis
Keyword(s):  
Heart Failure ◽  
Catheter Ablation ◽  
Ejection Fraction ◽  
Rate Control ◽  
Meta Analysis ◽  
Group Analysis ◽  
Rhythm Control ◽  
Significant Heterogeneity ◽  
Heart Failure Patients ◽  
Randomized Controlled

Background: Atrial fibrillation (AF) can exacerbate/worsen heart failure. A randomized study showed that rhythm control with anti-arrhythmic drugs (AADs) is not superior to rate control for heart failure patients who develop AF. However, a recent study revealed catheter ablation can improve the ejection fraction (EF) compared to medical rate control. Hypothesis: We performed a meta-analysis to compare the effect of rhythm control and medical rate control on EF in heart failure patients with AF. Methods: We searched PubMed, Embase, Google Scholar and Cochrane databases for all randomized controlled trials (RCTs) comparing rhythm control versus rate control for AF in heart failure. Primary outcome was change in EF. Random effects model was used to pool and analyze data across the studies. Results: Of a total of 7 RCTs (4 - AADs, 3 - catheter ablation) which compared rhythm control and medical rate control, 4 studies (n=202) reported quantitative data on EF. There was significant heterogeneity between the studies (I2=82%, p <0.001). Compared to rate control, the mean improvement in EF with rhythm control was 5.94% (95% CI 0.63- 11.26, p=0.03). Sub-group analysis revealed catheter ablation improved the EF by 6.67% (95% CI 0.23 -13.11, p=0.04) whereas rhythm control with AADs did not significantly change EF (3.50, -1.76 -8.76). Conclusion: Rhythm control is associated with greater improvement in EF compared to rate control therapy in heart failure patients with AF. Catheter ablation of AF significantly improves the EF in these patients. Further studies are needed to determine if this improvement in EF is associated with decreased morbidity and mortality.

scholarly journals Comparative Effectiveness of Early Rhythm Control Versus Rate Control for Cardiovascular Outcomes in Patients With Atrial Fibrillation

2021 ◽  
Author(s):  
Daehoon Kim ◽  
Pil‐Sung Yang ◽  
Seng Chan You ◽  
Eunsun Jang ◽  
Hee Tae Yu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Rate Control ◽  
Cardiovascular Death ◽  
Population Based ◽  
Cardiovascular Outcomes ◽  
Rhythm Control ◽  
Control Treatment ◽  
Control Rhythm

Background Rhythm control is associated with better cardiovascular outcomes than usual care among patients with recently diagnosed atrial fibrillation (AF). This study investigated the effects of rhythm control compared with rate control on the incidence of stroke, heart failure, myocardial infarction, and cardiovascular death stratified by timing of treatment initiation. Methods and Results We conducted a retrospective population‐based cohort study including 22 635 patients with AF newly treated with rhythm control (antiarrhythmic drugs or ablation) or rate control in 2011 to 2015 from the Korean National Health Insurance Service database. Propensity overlap weighting was used. Compared with rate control, rhythm control initiated within 1 year of AF diagnosis decreased the risk of stroke. The point estimates for rhythm control initiated at selected time points after AF diagnosis are as follows: 6 months (hazard ratio [HR], 0.76; 95% CI, 0.66–0.87), 1 year (HR, 0.78; 95% CI, 0.66–0.93), and 5 years (HR, 1.00; 95% CI, 0.45–2.24). The initiation of rhythm control within 6 months of AF diagnosis reduced the risk of hospitalization for heart failure: 6 months (HR, 0.84; 95% CI, 0.74–0.95), 1 year (HR, 0.96; 95% CI, 0.82–1.13), and 5 years (HR, 2.88; 95% CI, 1.34–6.17). The risks of myocardial infarction and cardiovascular death did not differ between rhythm and rate control regardless of treatment timing. Conclusions Early initiation of rhythm control was associated with a lower risk of stroke and heart failure–related admission than rate control in patients with recently diagnosed AF. The effects were attenuated as initiating the rhythm control treatment later.

scholarly journals Outcomes of heart failure with preserved ejection fraction after radiofrequency catheter ablation for atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
T Zolotarova ◽  
M Brynza ◽  
O Bilchenko
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Control Strategy ◽  
Rate Control ◽  
Left Ventricle Ejection Fraction ◽  
Preserved Ejection Fraction

Abstract Funding Acknowledgements Type of funding sources: None. Introduction. Recent randomized controlled trials have shown that in heart failure (HF) patients with reduced left ventricle ejection fraction (HFrEF) atrial fibrillation (AF) ablation reduces hospitalization and mortality due to HF compared to medical therapy (MT). However, only few studies have examined outcomes of catheter ablation (CA) for AF in HF patients with preserved left ventricle ejection fraction (HFpEF).  Purpose. To compare the effect of catheter ablation on the outcomes of atrial fibrillation with chronic heart failure with preserved ejection fraction. Methods. Our prospective study included the main group (136 patients with the HFpEF who underwent a single procedure of the CA for symptomatic AF) and control group (58 patients with the HFpEF patients with paroxysmal or persistent AF on MT for rhythm and rate control strategy). To be eligible for inclusion for both groups, left ventricular diastolic dysfunction had to be present and/or relevant structural heart disease according to the current guidelines had to be fulfilled within 6 months prior to AF ablation. Outpatient follow-up were performed at 6, 12, 24 months intervals thereafter baseline.  Results. At the follow-up the composite primary end point (all-cause death or worsening of HF that led to an unplanned hospitalization) appeared in significantly fewer patients in the CA group than in the MT group (18 (13,2%) patients vs. 16 (27,5%) patients; p =0,005). The secondary analyses showed there was 5 deaths in the CA group and 2 deaths in MT group, with rate of 3,7%  and 3,4% respectively that were equal in comparable groups (p = 0,362). The incidences of HF hospitalization and cardiovascular hospitalization were also significantly higher in MT group than in CA group (14 (24,1%) vs. 13 (9,6%), p = 0,005) vs. 21 (15,4%), p = 0,016, respectively). Cardiovascular death and cerebrovascular accident were equal in comparable groups. The Kaplan–Meier curve for primary end-point demonstrated significant higher survival and freedom from hospitalizations due to HF in the CA group compared to MT group (p = 0,005); the freedom from hospitalization for worsening HF and the freedom from the cardiovascular hospitalization were having higher probability in the СA group (p = 0,003 and p= 0,016 ). Conclusion. Comparing catheter ablation with medical therapy for rhythm or rate control strategy in patients with heart failure with preserved left ventricle ejection fraction and atrial fibrillation, we found that catheter ablation was associated with lower rate of deaths and hospitalization due to worsening of heart failure.

scholarly journals P1741 Echocardiographic assessment of rate versus rhythm control strategy in patients with persistent atrial fibrillation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
R Piatkowski ◽  
D A Kosior ◽  
J Kochanowski ◽  
M Szulc
Keyword(s):  
Control Strategy ◽  
Rate Control ◽  
Left Atrial ◽  
Persistent Atrial Fibrillation ◽  
Left Ventricular ◽  
Rhythm Control ◽  
Control Group ◽  
And Function ◽  
Left Ventricular Morphology

Abstract BACKGROUND Patients with persistent atrial fibrillation (AF) can be managed with either rhythm or rate control strategy. The restoration and maintenance of the sinus rhythm (SR) is not superior to the rate control regarding the total mortality and the rate of thromboembolic complications. Data concerning the effect of these strategies on left ventricular morphology and function is missing. PURPOSE The objective of our prospective randomised multicenter study in patients with persistent AF was to evaluate the effect of these two approaches on left ventricular morphology and function. METHODS The study group consisted of 205 patients (F/M 71/134; mean age 60.8 ± 11.2 years), including 101 patients randomized to the rate control approach (Group I) and 104 patients randomized to SR restoration with cardioversion and subsequent antiarrhythmic drug treatment (Group II). Mean duration of AF was 231.8 ± 112.4 days. At the end of follow-up (12 months), SR was present in 64% of patients in Group II. Echocardiographic examination was performed at a baseline and at 2 and 12 months. In the rate-control group, both right (22.1 ± 4.1 vs. 23.2 ± 3.8 cm2; p &lt; 0.05) and left atrial (25.9 ± 5.2 vs. 26.8 ± 4.6 cm2 p &lt; 0.05) enlargement was observed during the 12 months follow-up. A significant decrease in right (21.8 ± 3.0 vs. 21.2 ± 3.5 cm2; p &lt; 0.05) and left atrial (26.2 ± 4.6 vs. 25.5 ± 5.0 cm2; p &lt; 0.05) size in the rhythm control arm was observed. Both strategies led to a significant increase in left ventricular fractional shortening (32.1 ± 7.3 vs. 34.2 ± 6.5% and 31.3 ± 6.7 vs. 35.5 ± 8.9%, respectively; p &lt; 0.05). The comparison of the left ventricular end-diastolic diameter revealed no difference within and between groups (50.8 ± 5.6 mm vs. 52.2 mm ± 6.8 mm at a baseline and 50.0 ± 6.0 vs. 52.0 ± ± 7.4 mm at 12 months, respectively). In rhythm-control group such trend was observed only in pts. with successfully maintained SR. According to LV function improvement, rhythm-control strategy was preferred in pts. with hypertension (RR 2.63; 95% C.I.: 0.93-5.45; p &lt; 0.05) or congestive heart failure in NYHA II or III class (RR 2.13; 95% C.I.: 0.98-4.42; p &lt; 0.05). CONCLUSIONS Both strategies led to a significant increase in LV FS. Rate-control strategy led to right and left atrium enlargement, but rhythm control resulted in their decrease.

A comparison of rate control and rhythm control in tachycardia induced cardiomyopathy patients with persistent atrial flutter

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Oka ◽  
T Kai ◽  
K Hoshino ◽  
K Watanabe ◽  
J Nakamura ◽  
...  
Keyword(s):  
Heart Rate ◽  
Catheter Ablation ◽  
Control Strategy ◽  
Rate Control ◽  
Rhythm Control ◽  
Control Group ◽  
Lv Function ◽  
Strategy Group ◽  
Average Heart Rate ◽  
Tachycardia Induced Cardiomyopathy

Abstract Background/Introduction Tachycardia induced cardiomyopathy (TIC) is a potentially reversible dysfunction of the left ventricle (LV) caused by tachyarrhythmias. Early recognition of TIC and treatment of the culprit arrhythmia using pharmacological therapy or catheter ablation results in the recovery of LV function. For atrial flutter (AFL)-induced TIC, rhythm control strategy, such as catheter ablation has been recommended. On the other hand, the efficacy of rate control strategy has remained unclear due to the difficulty of control with arrhythmic medications. However, not all patients can take rhythm control treatments due to their backgrounds. Purpose The aim of this cohort study was to establish whether rate control strategy using β-blocker is as effective as invasive rhythm control strategy for the recovery of LV function in patients with TIC due to AFL. Methods We prospectively assessed 47 symptomatic non-ischaemic heart failure (HF) patients with left ventricular ejection fraction (LVEF) below 50% and suspected TIC induced by persistent AFL. Patients were divided into rhythm control strategy group (n=22, treatment: catheter ablation, electrical cardioversion) and rate control strategy group (n=25, treatment: bisoprolol). As a sub-group study, the rate control strategy group was divided into the strict rate control group (n=12, average heart rate below 80 bpm) and lenient rate control group (n=13, average heart rate below 110 bpm). The primary outcome was the recovery of LV function, defined as an increase of LVEF over 20% or to a value of 55% or greater after 6 months. Results There were no significant differences in baseline AFL heart rate, New York Heart Association class, LVEF, estimated glomerular filtration rate, and brain natriuretic peptide between the two groups. A greater proportion of patients who showed the recovery of LVEF after 6 months belonged to the rhythm control strategy group (90.9% vs. 52.0%, p=0.004). The cumulative incidence of HF re-hospitalization was significantly higher in the rate control strategy group than in the rhythm control strategy group (hazard ratio: 4.90, 95% CI: 1.06–22.69). As a result of sub-group study, LVEF recovery was greater in the strict rate control group compared to the lenient rate control group (75.0% vs. 30.8%, p=0.027) Conclusion Rate control strategy was significantly inferior to rhythm control strategy for the recovery of LVEF in TIC patients with persistent AFL. Rhythm control should be the first choice in the management of TIC with AFL, and strict rate control should be an alternative if rhythm control is not available. Primary outcomes Funding Acknowledgement Type of funding source: None

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