Rate vs Rhythm Control in Atrial Fibrillation

Rate vs Rhythm Control in Atrial Fibrillation Rate vs rhythm control as a management strategy in atrial fibrillation has been a long standing topic for debate. Though at one look rhythm control would appear to be the ideal strategy, long term adverse effects of the currently available medications for rhythm control is the often cited down side. AFFIRM [1] and RACE [2] trials were the main reason for the debate as they failed to show any benefit for the rhythm control strategy. AF-CHF trial in those with AF and congestive heart failure also failed to show any advantage for the rhythm control strategy [3]. But there have been important criticisms as well [4]. In AFFIRM, only 45% of the eligible patients were randomized to a rate vs rhythm control strategy. Nearly two thirds in the rhythm control strategy were on amiodarone and only 14 had catheter ablation. Many were not in sinus rhythm or anticoagulated. It was the negative results of the trials that caused rhythm control strategy which needs more skill in the use of antiarrhythmic drugs and can cause proarrhythmia or adverse effects, was relegated to the back stage. So it is clear that it was not rhythm control which was inferior, but the adverse effects of the currently available medications for rhythm control, which was inferior. That is how the strategy of rhythm control by catheter ablation was thought of as a possible better strategy, though technically more challenging, not uniformly effective and having significant ris...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: ECG / Electrophysiology General Cardiology Source Type: blogs