Arrhythmias & electrophysiology
Risk of syncope and permanent pacing with rate vs rhythm control of atrial fibrillation: A systematic review and meta-analysis
Pooled result · Composite of syncope, falls, or pacemaker implantationResult — go to the resultOdds ratio 1.28 95% CI 1.14–1.44Authors' conclusion
In this meta-analysis, rhythm control was associated with an increased risk of syncope, falls, or pacemaker implantation compared with rate control. These risks should be carefully weighed when choosing between rate control and rhythm control strategies.
Study context
- Population
- Patients with atrial fibrillation (AF) treated with rate control vs rhythm control strategies3 randomized controlled trials and 6 cohort studies
- Participants
- 522,841 patients
- Comparison
- Rate control vs rhythm control strategies
- Rate controln = 348,831reference
- Rhythm controln = 174,010
- Outcome
- Composite of:
- Syncope
- Falls
- Pacemaker implantation
Methodological detailsrandom-effects model
- Random-effects model
Pooled result
As reported in the abstract
Odds ratio
1.28
95% CI 1.14–1.44
P < 0.0001
Rhythm controlvs Rate control
OR 1.28 (95% CI 1.14–1.44); P < 0.0001
Further pooled results
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| SyncopeI2 = 85% · secondary outcome | 1.64 (1.16–2.32) | P = 0.005 | |
| Pacemaker implantationI2 = 97%; trend toward a higher rate with rhythm control · secondary outcome | 1.96 (0.98–3.93) | P = 0.06 | |
| 0.20.5125Odds ratio (log scale) |
Original publication
Risk of syncope and permanent pacing with rate vs rhythm control of atrial fibrillation: A systematic review and meta-analysis. Heart Rhythm. Published 14 August 2025. doi:10.
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