AF-CHF: Rhythm Control versus Rate Control for Atrial Fibrillation and Heart Failure Multicenter, prospective, randomized, controlled trial Objective: To assess if rhythm-control reduce CV mortality in patients with AF and HFrEF as compared to rate control. Patients with AF and HFREF rate control rhythm control CV mortality 1,376 patients with nonvalvular atrial fibrillation and HFREF (LVEF <35% and NYHA II-IV symptoms) rhythm control (pharmacologic or VS Rate control (<80 bpm at rest) (n=694) electrical approach) (n=682) 27% 25% HR 1.06; 95% CI 0.86-1.3; P=0.59 Primary Outcomes Cardiovascular mortality Secondary Outcomes 43% Composite of all-cause mortality, stroke, worsening heart failure HR 0.9; 95% CI 0.77-1.06, P=0.2 46% 14% hospitalization for AF P=0.001 9% In patients with atrial fibrillation and CHF, a routine strategy of rhythm control does not reduce the rate of death from CV causes, as compared with a rate-control strategy. Roy D, et al. NEJM, 2008. 358(25):2667-2677.