(a) Yamashita T, Ogawa S, Aizawa Y, Atarashi H, Inoue H, Ohe T, Okumura K, Kato T, Kamakura S, Kumagai K, Kurachi Y, Kodama I, Koretsune Y, Saikawa T, Sakurai M, Sugi K, Nakaya H, Nakayama T, Hirai M, Fukatani M, Mitamura H, Yamazaki T
(b) Ogawa S, Yamashita T, Yamazaki T, Aizawa Y, Atarashi H, Inoue H, Ohe T, Ohtsu H, Okumura K, Katoh T, Kamakura S, Kumagai K, Kurachi Y, Kodama I, Koretsune Y, Saikawa T, Sakurai M, Sugi K, Tabuchi T, Nakaya H, Nakayama T, Hirai M, Fukatani M, Mitamura H

(a) Investigation of the optimal treatment strategy for atrial fibrillation in Japan. The J-RHYTHM (Japanese Rhythm Management Trial for Atrial Fibrillation) study design
(b) Optimal treatment strategy for patients with paroxysmal atrial fibrillation. J-RHYTHM study

(a) Circ J 2003;67:738–41
(b) Circ J 2009;73:242–8

Atrial fibrillation

To compare the effects of rhythm control therapy and rate control therapy, in combination with antithrombotic therapy, in patients with atrial fibrillation

Randomised

Mean 578 days

885 patients (442 rate control, 443 rhythm control), mean age 64.7 ± 11.3 years, with paroxysmal or persistent atrial fibrillation

Rate control: digitalis, calcium antagonist or beta-blocker to target 60–80 beats/min at rest. Rhythm control: antiarrhythmic drugs according to the Japanese Guideline for Atrial Fibrillation Management. Electrical cardioversion in case of persistent atrial fibrillation

Antithrombotic drugs in all patients

823 patients (404 rate control, 419 rhythm control) were included in the analysis. The primary composite endpoint of total mortality, symptomatic cerebral infarction, systemic embolism, major bleeding, hospitalisation for heart failure requiring iv administration of diuretics, and physical/psychological disability requiring alteration of the assigned treatment strategy occurred in 22.0% of rate-control patients and 15.3% of rhythm-control patients (p = 0.0128). There were no significant differences between the groups in the incidences of death, stroke, bleeding or heart failure