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of the study),2 we think that exposure times to each of the strategies and therapies need to be taken into account. To do this, a time-dependent, on-treatment analysis would be necessary, whereby patients are analyzed according to the actual therapy received, and adverse events or outcomes are attributed to the treatments actually applied. 3 The necessity for this is stressed by the survival curves for noncardiovascular mortality, where ex- cess mortality in the rhythm control arm began to emerge after 1 year of treatment.1 By that time, the crossover from rhythm to rate control was already substantial (rates of 16.7%, 27.3%, and 37.5% were recorded at 1, 3, and 5 years, respectively).2 In addition to evaluation of time-dependent covariates, a series of known potential determinants of pulmonary and cancer-related mortality (including environmental, lifestyle, and occupational factors) also require consideration. Such an analysis would allow a more reliable exploration of the possible relations between rhythm control and occurrence of pulmonary and cancer-related deaths.

Rhythm Control and Increased Risk of Noncardiovascular Death in the Atrial Fibrillation Follow-up Investigation of Rhythm Management Trial