Methods
atrial fibrillation, valve dysfunction, postoperative atrial fibrillation
ATRIAL FIBRILLATION, HEART FAILURE
The design of this trial has been described in detail in our protocol for this trial [CONSORT flow diagram
Participants with either persistent (defined as atrial fibrillation lasting for more than 7 days) or permanent (rate control is considered the only treatment option) atrial fibrillation confirmed by 12-lead electrocardiogram (ECG) at inclusion. Participants with postoperative atrial fibrillation who meet the listed inclusion criteria and none of the exclusion criteria will be eligible as well.Rate control must be accepted as the primary management strategy.Informed consent.Adult (18 years or older).
No informed consentInitial heart rate below 80 bpm at rest (assessed by 12-lead ECG before randomization)Oral anticoagulant therapy of non-vitamin K oral anticoagulants (NOACs) of less than 3-week duration or warfarin with international normalized ratio (INR) levels within therapeutic range or less than 4 weeksIf the treating physician deems that the participant is not suitable to be randomized into both groups based on an individual assessment. This decision will be made before randomization by the treating physician. This can, for example, include participants depending on a high ventricular rate to maintain a sufficient cardiac output, such as patients with heart failure, a hemodynamically significant valve dysfunction, or severely dehydrated participantsParticipants who are hemodynamically unstable and therefore require immediate electrical cardioversion