[Advantages of restoration and maintenance of sinus rhythm in middle aged patients with atrial fibrillation and chronic heart failure].

Patients (n=223, age 47-64 years) with persistent nonvalvular atrial fibrillation and functional class II-III chronic heart failure were treated for 2 years with aims of sinus rhythm control (n=113, strategy 1) or slowing of heart rate (n=110, strategy 2). Strategy 1 compared with strategy 2 was associated with lower total (11.5 and 22.7%; respectively, p<0.05), and cardiovascular (9.7 and 20%, respectively; p<0.05) mortality, as well as ischemic stroke rate (13.3 and 25.5%,respectively; p<0.05). Strategy 1 was also associated with elevation of exercise tolerance, reduction of clinical signs of chronic heart failure, augmentation of left ventricular ejection fraction, and improvement of quality of life. Restoration and maintenance of sinus rhythm in patients aged <65 years with atrial fibrillation and chronic heart failure appears to be justified. However large randomized trial is required for testing of this hypothesis.