Why the study?
Does restoration of sinus rhythm improve overall survival or quality of life compared to ventricular rate control in patients with persistent atrial fibrillation?
Does restoration of sinus rhythm improve overall survival or quality of life compared to ventricular rate control in patients with persistent atrial fibrillation?
This review highlights the lack of prospective data favoring either rhythm or rate control for persistent atrial fibrillation, setting the stage for ongoing clinical trials.
Equipoise persists between rhythm and rate control for survival or QoL in persistent AF; leaves open optimal strategy pending prospective trials.
In patients with persistent atrial fibrillation, two therapeutic alternatives exist, namely restoration and maintenance of sinus rhythm versus ventricular rate control combined with anticoagulation. Currently, the selection of the best therapeutic strategy in an individual patient relies for the most part on clinical judgement and personal experience. At present, there are no prospective scientific data to support the superiority of one treatment over the other with respect to overall survival or quality of life. This review summarizes the present knowledge on this important clinical problem with particular emphasis on issues such as efficacy of antiarrhythmic drugs to prevent recurrent atrial fibrillation, proarrhythmic hazards of these compounds, or efficacy and safety of anticoagulation in nonrheumatic atrial fibrillation. These data serve as the basis of ongoing clinical trials prospectively comparing the merits and demerits of the two therapeutic strategies in the most common arrhythmia encountered in clinical practice.
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Li et al. (1998) studied this question.
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