Therapeutic Options for Atrial Fibrillation: Rhythm Control or Rate Control Strategy

Recently therapeutic options for the treatment of atrial fibrillation (AF) became more extent, as pharmacological and mapping technology develop. However, the treatment for the restoration and maintenance of sinus rhythm in patients with persistent AF and progressed atrial remodeling remains unsatisfied even utilizing both pharmacological and nonpharmacological therapies.Up to present, there are a total of 5 clinical randomized trials investigating which therapeutic strategy (rhythm control or rate control) is superior in terms of improvement in the patients' prognosis and quality of life. In all the trials, there were no significant differences in the incidence of end-points including all-cause death, embolic and hemorrhagic events between two strategies, although the cumulative mortality tended to be higher for the rhythm control strategy in AFFIRM trial. On the contrary, exercise tolerance (6 minutes walk) was improved to the greater degree for the rhythm control strategy in PIAF trial. Because most of these trials recruited the patients with high risk patients of thrombo-embolic complications such as older age, persistent or chronic AF, reduced cardiac function and so on, it is suggested that the rhythm control therapy might improve the QOL and even mortality, by selecting candidates appropriately for the rhythm control therapy.