A review highlighting the limitations of current antiarrhythmic drugs and ablation for AF, emphasizing the need for appropriate antithrombotic therapy regardless of rate or rhythm control strategy.
Supports antithrombotic therapy in AF regardless of rate/rhythm strategy; leaves open refinement of antiarrhythmic drugs and ablation.
As the most common sustained cardiac arrhythmia, the health burden presented by atrial fibrillation (AF) continues to grow. One of the current dilemmas in managing AF lies in the decision of whether to pursue a rate or rhythm control strategy. Current antiarrhythmic drugs have many limitations in terms of efficacy and adverse effects, and the availability of better antiarrhythmic drugs that are effective and safe would probably improve outcomes in AF. Enthusiasm for pulmonary vein ablation procedures has been tempered by the relatively high frequency of recurrences of AF, which are often asymptomatic. Ablation also frequently converts symptomatic episodes to asymptomatic recurrences. Irrespective of whether a rate control or a rhythm control strategy is adopted in patients with persistent AF, appropriate antithrombotic therapy should be used.
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Watson et al. (2006) studied this question.
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