Abstract Body (Do not enter title and authors here):
Background: The prevalence of atrial fibrillation (AF) increases with age. However, limited data are available regarding the prognostic implications of rhythm versus rate control strategies for AF in the elderly. We have conducted this systematic review and meta-analysis to explore the effects of early rhythm control strategy in elderly (age >65 years) AF patients.

Methods: A literature search was conducted for relevant studies using MEDLINE (PubMed), EMBASE, Scopus, Cochrane CENTRAL, Conference Abstracts, and ClinicalTrials.com through March 19th, 2024. The primary outcome was all-cause mortality. Meta-analysis was performed using the random-effects Mantel-Haenszel method, and pooled risk ratios (RRs) along with 95% confidence intervals (CIs) were calculated using RevMan 5.4.

Results: Six studies with 39,181 patients (rhythm control 11,446; rate control 27,735) were included. The mean age was 79 years in the rhythm control and 81 years in the rate control cohort. Females were 52% in rhythm control and 55% in the rate control group. The rhythm control strategy was associated with a lower risk of stroke (RR 0.73, 95%CI 0.66-0.81, p<0.0001, I²=44%) but had a higher risk of permanent pacemaker (PPM) implantation (RR 2.54, 95%CI 1.04-6.23, p=0.04, I²=29%). Rhythm control did not improve all-cause mortality (RR 0.90, 95%CI 0.72-1.11, p=0.32, I²=96%) or cardiovascular mortality (RR 0.87, 95%CI 0.62-1.23, p=0.43, I²=75%) in elderly AF patients.

Conclusion: Rhythm control strategy in elderly patients is associated with a lower risk for stroke but has a higher risk for PPM implantation. Additionally, there is a comparable risk for all-cause mortality and cardiovascular mortality between rhythm and rate control treatments for elderly AF patients.