Strict vs. Lenient Heart-Rate Control

Strict control of heart rates in patients with atrial fibrillation proved no more beneficial than lenient control, according to new recommendations from the American Heart Association and other organizations.

Atrial fibrillation, which affects some 2 million Americans, occurs when the heart beats irregularly, causing the chambers to pump blood rapidly, unevenly and inefficiently. As a result, blood clots can form in the heart's chambers, break free and cause stroke or heart attack.

Based on new recommendations -- updates of the 2006 Guidelines for the Management of Patients with Atrial Fibrillation -- a patient’s heart rate (at less than 80 beats per minute at rest and less than 110 during a six-minute walk) does not benefit from strict treatment controls over a more lenient approach. The aim of treatment in this instance is to achieve a resting heart rate of less than 110 in patients with continuous atrial fibrillation with stable functioning of the heart’s lower chambers (the ventricles).

The evidence showed rigid control did not seem to benefit patients,” said L. Samuel Wann, M.D., chair of the focused update writing group and director of cardiology at the Wisconsin Heart Hospital in Milwaukee. “We don’t need to be as compulsive about absolute numbers, particularly doing exercise tests and giving multiple drugs based solely on heart rate."