Routine versus aggressive upstream rhythm control for prevention of early atrial fibrillation in heart failure: background, aims and design of the RACE 3 study

M. Alings, M. D. Smit, M. L. Moes, H. J. G. M. Crijns, J. G. P. Tijssen, J. Brugemann, H. L. Hillege, D. A. Lane, G. Y. H. Lip, J. R. L. M. Smeets, R. G. Tieleman, R. Tukkie, F. F. Willems, R. A. Vermond, D. J. Van Veldhuisen, I. C. Van Gelder*

*Corresponding author for this work

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Rhythm control for atrial fibrillation (AF) is cumbersome because of its progressive nature caused by structural remodelling. Upstream therapy refers to therapeutic interventions aiming to modify the atrial substrate, leading to prevention of AF. The Routine versus Aggressive upstream rhythm Control for prevention of Early AF in heart failure (RACE 3) study hypothesises that aggressive upstream rhythm control increases persistence of sinus rhythm compared with conventional rhythm control in patients with early AF and mild-to-moderate early systolic or diastolic heart failure undergoing electrical cardioversion. RACE 3 is a prospective, randomised, open, multinational, multicenter trial. Upstream rhythm control consists of angiotensin converting enzyme inhibitors and/or angiotensin receptor blockers, mineralocorticoid receptor antagonists, statins, cardiac rehabilitation therapy, and intensive counselling on dietary restrictions, exercise maintenance, and drug adherence. Conventional rhythm control consists of routine rhythm control therapy without cardiac rehabilitation therapy and intensive counselling. In both arms, every effort is made to keep patients in the rhythm control strategy, and ion channel antiarrhythmic drugs or pulmonary vein ablation may be instituted if AF relapses. Total inclusion will be 250 patients. If upstream therapy proves to be effective in improving maintenance of sinus rhythm, it could become a new approach to rhythm control supporting conventional pharmacological and non-pharmacological rhythm control.
Original languageEnglish
Pages (from-to)354-363
JournalNetherlands Heart Journal
Issue number7-8
Publication statusPublished - Jul 2013


  • Atrial fibrillation
  • Secondary prevention
  • Upstream therapy
  • Heart failure

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