Restoration and maintenance of sinus rhythm provide important haemodynamic and subjective benefits compared to rate control, making early intervention a critical goal.
Does early restoration and maintenance of sinus rhythm improve haemodynamic and subjective outcomes compared to rate control in patients with atrial fibrillation?
This review highlights the progressive nature of atrial fibrillation and argues for early rhythm control to provide hemodynamic and subjective benefits and limit disease progression.
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting young as well as elderly patients and presenting a major therapeutic challenge for clinical cardiologists. Recent research has elucidated the progressive nature of AF, including the structural and electrical remodelling that may become manifest if normal sinus rhythm is not restored, and the serious morbidities associated with long-term disease. The controversy over the merits of ventricular rate control vs. the restoration and maintenance of normal sinus rhythm in the treatment of AF has been explored in a number of large-scale, randomized clinical trials. The results of these trials suggest that whereas the two strategies may be equivalent for some patient populations, with both approaches requiring accompanying anticoagulation therapy, the restoration and maintenance of sinus rhythm provide important haemodynamic as well as subjective benefits not afforded by rate control. Although early intervention to limit the progression of this arrhythmia is hindered by the limitations of existing anti-arrhythmic therapies, it is nevertheless a critical goal.
Gelder et al. (Thu,) conducted a review in Atrial fibrillation. Restoration and maintenance of sinus rhythm vs. Ventricular rate control was evaluated. Restoration and maintenance of sinus rhythm provide important haemodynamic and subjective benefits compared to rate control, making early intervention a critical goal.