Via practica 9/2006

ATRIAL FIBRILLATION: TO ACCEPT THE ARRHYTHMIA OR TO PUSH FOR SINUS RHYTHM?

Two epidemics of cardiovascular disease are recognized nowadays: heart failure and atrial fibrillation (AF). AF is the most common sustained arrhythmia in clinical practice and is strongly age-dependent in prevalence. AF has a significant impact on morbidity and mortality. The optimal management of atrial fibrillation is of considerable clinical importance and involves three areas: rate control, rhythm control, and anticoagulation. In the past, rhythm control of atrial fibrillation was generally preferred over rate control, in the belief that it offered better symptomatic relief, quality of life, eliminated the need for anticoagulation, and improved mortality. Several recent randomized trials (AFFIRM, RACE, STAF, PIAF) comparing rate control and rhythm control strategies for the treatment of patients with AF have shown no difference in mortality between these approaches. This article further analyzes the pros and cons of both treatment modalities. With the recent advances in the understanding of the mechanisms of atrial fibrillation, radiofrequency catheter ablation has emerged as an effective therapeutic modality for patients with AF. However, it would be an mistake to utilize one management strategy for all patients with atrial fibrillation. The optimal approach needs to be individually tailored for each patient.

Keywords: atrial fibrillation, sinus rythm, control of ventricular response.