Rhythm control in atrial fibrillation

• Published in: The Lancet (British edition) Vol. 388; no. 10046; pp. 829 - 840
• Main Authors: Piccini, Jonathan P, Dr, Fauchier, Laurent, MD
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 20.08.2016; Elsevier Limited; Elsevier
• Subjects: Administration, Oral; Anti-Arrhythmia Agents - therapeutic use; Anticoagulants; Anticoagulants - administration & dosage; Anticoagulants - therapeutic use; Atrial Fibrillation - drug therapy; Atrial Fibrillation - physiopathology; Cardiac arrhythmia; Cardiovascular diseases; Catheter Ablation - adverse effects; Clinical trials; Electric Countershock - adverse effects; Electric Countershock - methods; Electrocardiography; Heart failure; Heart Failure - drug therapy; Heart Failure - prevention & control; Heart rate; Heart Rate - drug effects; Humanities and Social Sciences; Humans; Internal Medicine; Medical instruments; Patients; Practice Guidelines as Topic; Quality of Life; Renal function; Stroke; Stroke - etiology; Stroke - prevention & control; Thromboembolism; Thromboembolism - etiology; Thromboembolism - prevention & control; Time Factors; Vitamin K - antagonists & inhibitors
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(16)31277-6

Summary Many patients with atrial fibrillation have substantial symptoms despite ventricular rate control and require restoration of sinus rhythm to improve their quality of life. Acute restoration (ie, cardioversion) and maintenance of sinus rhythm in patients with atrial fibrillation are referred to as rhythm control. The decision to pursue rhythm control is based on symptoms, the type of atrial fibrillation (paroxysmal, persistent, or long-standing persistent), patient comorbidities, general health status, and anticoagulation status. Many patients have recurrent atrial fibrillation and require further intervention to maintain long term sinus rhythm. Antiarrhythmic drug therapy is generally recommended as a first-line therapy and drug selection is on the basis of the presence or absence of structural heart disease or heart failure, electrocardiographical variables, renal function, and other comorbidities. In patients who continue to have recurrent atrial fibrillation despite medical therapy, catheter ablation has been shown to substantially reduce recurrent atrial fibrillation, decrease symptoms, and improve quality of life, although recurrence is common despite continued advancement in ablation techniques.