Progression of Atrial Fibrillation From Paroxysmal to Persistent

Rhythm control therapy in atrial fibrillation (AF) restores maintains sinus rhythm using antiarrhythmic drugs, electrical cardioversion, and catheter ablation. The presence of sinus rhythm usually increases cardiac functional reserve, prevents stroke events, and improves quality of life. Hence, rhythm control is considered superior and rate control strategy is the second option after failure of the rhythm control strategy, which means progression of paroxysmal AF to persistent or permanent AF. A large-scale randomized study, Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM), was carried out to determine which strategy was better for treatment of patients with AF. 1 Approximately 4,000 patients with baseline characteristics showing they were at high risk for stroke were enrolled and randomized to either a rate or rhythm control strategy and then followed up. The results revealed that rhythm control strategy using antiarrhythmic drugs did not offer any survival advantages for patients with AF compared with the rate control strategy. The importance of anticoagulant therapy for the prevention of stroke was also demonstrated in both strategies. Physicians who believed that rhythm control was better than rate control were disappointed by the results of AFFIRM.