A 55-year-old man with persistent atrial fibrillation, LVEF 58% and minimal symptoms is being started on rate control therapy. According to the RACE II trial strategy adopted in current guidelines, what resting heart rate target is acceptable for him?
- A Resting heart rate below 80 bpm
- B Resting heart rate below 110 bpm ✓
- C Resting heart rate below 60 bpm
- D Resting heart rate below 100 bpm with heart rate below 110 on six-minute walk
Correct answer: B. Resting heart rate below 110 bpm
Explanation
The RACE II randomized trial showed that a lenient resting rate target under 110 bpm was non-inferior to strict control under 80 bpm regarding composite cardiovascular outcomes, with fewer drug side effects and less hospitalization, in patients with preserved LV function and mild symptoms. Strict targets remain appropriate for patients who stay symptomatic or develop tachycardia-induced cardiomyopathy. Targets of 60 or 80 bpm reflect the older strict strategy, not current default practice.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.