In general, AF is shown to be associated with poorer NYHA functional class, more symptomatic HF, as well as with greater requirements for ACE inhibitors and diuretics, in all subgroups of the AFFIRM trial except for those patients who crossed over from rhythm to rate control, while the highest rate of symptomatic HF patients was reported among patients who changed strategy between rate and rhythm control more than once. This evidence concerns the gene ACE and hydrops fetalis.