Rate Versus Rhythm Control Pharmacotherapy For Atrial Fibrillation: Where are We in 2008?

Journal of Atrial Fibrillation
James A Reiffel

Abstract

Atrial fibrillation (AF) is the most common sustainedcardiac rhythm disturbance encountered by physicians. The management of AF isfocused on control of heart rate, correction of rhythm disturbance, andrisk-determined prophylaxis of thromboembolism. The goals of AF therapy are, aswith other serious disorders, to reduce mortality (if possible) and morbidity(improve quality of life, [QOL]). To this end, several large studies haveexamined rhythm-control versus rate-control strategies. Although a survivaladvantage to using rhythm control with currently available antiarrhythmic drugshas not been proven, neither has there been a significant excess risk versusrate control. Therefore, using our current therapies, the results have notsupported rate control or rhythm control as being a preferable first-linetherapy for AF as regards survival; importantly, neither do they disprove the hypothesis thatmaintenance of sinus rhythm is preferable to the continuation of AF,particularly if rate control fails to restore adequate QOL. Many post-hocanalyses and substudies have assessed QOL, functional status, and exercisetolerance, with the majority demonstrating important benefits associated withachievement of rhythm control. This review examines rat...Continue Reading

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