Conclusion
The bottom line is that rate control is at least as good as rhythm control strategy. A non-statistically significant increase in stroke is seen in the rhythm control group. No difference is seen in quality of life. The results of the AFFIRM trial and other clinical trials studying rate versus rhythm control are going to significantly change the way we treat AF. There is now much less push to try to convert a patient into sinus rhythm unless the patient is very symptomatic or rate control is difficult. However, it is important not to stop the anticoagulation. As far as antiarrhythmic drugs are concerned, it’s not always necessary to change the therapy every time a patient has an occurrence. If the patient is controlled, not symptomatic and on anticoagulation, they may not have to have their therapy changed.
The new strategy for AF based on the latest information is:
A Fib--> control rate and anticoagulate --> if patient's rate is controlled and symptom free, OK to leave in atrial fibrillation.
--> if still symptomatic, unable to control rate or other confounding reasons sinus rhythm is preferred
--> cardiovert (TEE guided to rule out clot or anti-coagulate x 4 weeks)
--> referral for experienced electrophysiologist if considering ablation for a fib (best candidates: young patients + a fib initiated by premature atrial complex who have failed drug therapy)
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This content is reviewed regularly. Last updated 12/5/08.
Full text, AHA, 2010
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