Contemporary rhythm control strategies, including catheter ablation, demonstrate safety in modern atrial fibrillation management, supporting a personalized approach based on patient preferences.
Does contemporary rhythm control treatment improve outcomes compared to rate control or drug therapy in patients with atrial fibrillation?
Recent landmark trials (EAST-AFNET 4 and CABANA) support the safety of contemporary rhythm control and catheter ablation, suggesting a personalized approach to AF management in the context of the 2020 ESC guidelines.
Prior randomised clinical trials (RCTs) have suggested that rhythm control offers no benefit compared to accepting AF and instituting rate control in terms of all-cause mortality, CV mortality and sudden death; as a consequence, the ESC AF guidelines have recommended rhythm control for reducing AF-related symptoms and improving quality of life. The Early Treatment of Atrial Fibrillation for Stroke Prevention Trial (EAST-AFNET 4) evaluated whether a more up-to-date rhythm control management strategy provides a benefit in mortality or stroke rates while the Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial evaluated whether catheter ablation was better than drug therapy in preventing a composite of death, disabling stroke, serious bleeding or cardiac arrest. This document critically reviews the recommendations of the 2020 ESC guidelines for the management of AF in the light of these two landmark trials, both of which have underlined the safety of contemporary rhythm control treatment. Considering the safety of the different strategies in modern AF treatment, a personalized approach taking into account the specific patient profile and preferences of the individual patient is needed.
Arbelo et al. (Thu,) conducted a review in Atrial fibrillation. Rhythm control and catheter ablation vs. Rate control and antiarrhythmic drug therapy was evaluated. Contemporary rhythm control strategies, including catheter ablation, demonstrate safety in modern atrial fibrillation management, supporting a personalized approach based on patient preferences.
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