MINI REVIEW article
Front. Cardiovasc. Med.
Sec. Cardiac Rhythmology
Outcomes of Early Rhythm Control versus Rate Control Strategies for Atrial Fibrillation in Late Elderly Patients: A Systematic Review and Meta-Analysis
Provisionally accepted
Soban Ahmad1*
Muhammad Junaid Ahsan2
Kathryn M. Kim1Mohammad Hamza Bin Abdul Malik3Sundus Ikram4
Michael Kim5- 1University of Nebraska Medical Center, Omaha, United States
- 2Baylor Scott & White Health, Dallas, United States
- 3Nassau University Medical Center, East Meadow, United States
- 4East Carolina University, Greenville, United States
- 5CHI Health Creighton University Medical Center, Omaha, United States
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Atrial fibrillation (AF) is highly prevalent in late elderly patients, yet optimal management remains uncertain. While early rhythm control has shown benefits in younger populations, evidence in patients over 75 years is limited, and rate control remains the main treatment strategy. We performed a systematic review and meta-analysis comparing early rhythm versus rate control in elderly AF patients. Seven retrospective studies with a total of 96,699 patients (27,771 rhythm control; 68,928 rate control) were analyzed. The mean ages were 78.1 and 79.5 years in the rhythm and rate control groups, respectively. Rhythm control was associated with a lower risk of stroke (RR 0.82, p=0.02) but a higher risk of permanent pacemaker implantation (RR 2.54, p=0.04). All-cause mortality and cardiovascular mortality were similar between the two groups. Our findings suggest that while early rhythm control may reduce stroke risk in the late elderly, it carries higher device-related risks without a mortality benefit. Treatment goals should be individualized and guided by patient comorbidities, preferences, and overall frailty.
Keywords: Atrial Fibrillation, Rhythm control, Rate control, Stroke, Mortality
Received: 22 Sep 2025; Accepted: 24 Nov 2025.
Copyright: © 2025 Ahmad, Ahsan, Kim, Abdul Malik, Ikram and Kim. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Soban Ahmad
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