OBJECTIVES: This study sought to compare whether gender affects the outcome of rate versus rhythm control treatment in patients with persistent atrial fibrillation(AF). BACKGROUND: Large trials have shown that rate control is an acceptable alternative to rhythm control. However, the effects of treatment may differ between male and female patients. METHODS: In the Rate Control versus Electrical Cardioversion(RACE)study,522 patients(192 female)were included and randomized to rate or rhythm control. The occurrence of cardiovascular end points and quality of life(QoL)were compared between female and male patients. RESULTS: At baseline, female patients differed from male patients with regard to age, underlying heart disease, diabetes mellitus, and left ventricular function. Female patients had more AF-related complaints, and QoL was significantly lower. After a mean follow-up of 2.3±0.6 years,cardiovascular morbidity and mortality was equally distributed between female(21%)and male patients(19%). However, in contrast to male patients, female patients randomized to rhythm control developed more end points(adjusted hazard ratio was 3.1[95%confidence interval 1.5 to 6.3], p=0.002), mainly heart failure, thromboembolic complications, and adverse effects of antiarrhythmic drugs, compared with rate control randomized female patients. During follow-up, QoL in female patients remained worse compared with that for male patients. Randomized strategy did not influence QoL in female patients. CONCLUSIONS: In female patients with persistent AF,a rhythm control approach leads to more cardiovascular morbidity and mortality. Because treatment strategy did not influence QoL in female patients, a rate control approach may be considered in these patients. OBJECTIVES: This study sought to compare whether gender affects the outcome of rate versus rhythm control treatment in patients with persistent atrial fibrillation (AF). However, the effects of METHODS: In the Rate Control versus Electrical Cardioversion (RACE) study, 522 patients (192 female) were included and randomized to rate or rhythm control. The occurrence of cardiovascular end points and quality of life ( Female patients had more AF-related complaints, and QoL was (QoL) were compared between female and male patients. RESULTS: At baseline, female patients differed from male patients with regard to age, underlying heart disease, diabetes mellitus, and left ventricular function. significantly lower. After a mean follow-up of 2.3 ± 0.6 years, cardiovascular morbidity and mortality was equally distributed between female (21%) and male patient However, in contrast to male patients, female patients randomized to rhythm control developed more end points (adjusted hazard ratio was 3.1 [95% confidence interval 1.5 to 6.3], p = 0.002), mainly heart failure, thromboembolic complications, and adverse effects of antiarrhythmic drugs, compared with rate control randomized female patients. During follow-up, QoL in female patients more than likely with that for male patients. with persistent AF, a rhythm control approach leads to more cardiovascular morbidity and mortality. Because treatment strategy did not affect QoL in female patients, a rate control approach may be considered in these patients.