AF-CHF Trial: Rhythm Control versus Rate Control for Atrial Fibrillation and Heart Failure

The AF-CHF trial is a multicenter, prospective, randomized, controlled trial that assessed if rhythm-control reduces CV mortality in patients with AF and HFrEF as compared to rate control. 1,376 patients with nonvalvular atrial fibrillation and HFrEF (LVEF ≤35% and NYHA II-IV symptoms) were randomized to rhythm control (pharmacologic or electrical approach (n=682) or rate control strategy (<80 bpm at rest) (n=694). No difference was found in terms of the primary outcome of CV mortality as well as the secondary outcome of a composite of all-cause mortality, stroke, worsening heart failure when both the groups were compared. The authors concluded that among patients with AF and HFrEF, rhythm-control did not reduce cardiovascular mortality but did reduce AF related hospitalizations, as compared to rate control. The AF-CHF trial was the second-largest trial that compared the two strategies of AF management. The largest trial is the AFFIRM trial which showed similar findings but included both heart failure as well no heart failure patients.