May 1, 2022Journal of the American College of Cardiology186 citationsOpen Access
The Increasing Role of Rhythm Control in Patients With Atrial Fibrillation
Structured PICO
Does early rhythm control reduce adverse cardiovascular outcomes in patients with atrial fibrillation?
P
Population
Patients with atrial fibrillation, specifically those with AF that has not become long-standing (early AF) and high-risk patients.
I
Intervention
Early rhythm control (typically antiarrhythmic drugs and/or AF ablation)
C
Comparator
Rate control
O
Outcome
Adverse cardiovascular outcomes (AF-related deaths, heart failure, and strokes)
Early rhythm control in patients with recent-onset atrial fibrillation has the potential to halt disease progression and reduce adverse cardiovascular outcomes, suggesting a need for wider adoption.
Abstract
The considerable mortality and morbidity associated with atrial fibrillation (AF) pose a substantial burden on patients and health care services. Although the management of AF historically focused on decreasing AF recurrence, it evolved over time in favor of rate control. Recently, more emphasis has been placed on reducing adverse cardiovascular outcomes using rhythm control, generally by using safe and effective rhythm-control therapies (typically antiarrhythmic drugs and/or AF ablation). Evidence increasingly supports early rhythm control in patients with AF that has not become long-standing, but current clinical practice and guidelines do not yet fully reflect this change. Early rhythm control may effectively reduce irreversible atrial remodeling and prevent AF-related deaths, heart failure, and strokes in high-risk patients. It has the potential to halt progression and potentially save patients from years of symptomatic AF; therefore, it should be offered more widely.