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Discusses the evolving paradigm of rhythm control in atrial fibrillation, particularly in the context of HFpEF and modern catheter-based therapies, reevaluating the historical rate-control preference established by the AFFIRM trial.
The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial, published more than 2 decades ago, profoundly shaped the landscape of atrial fibrillation (AF) management. Its seminal finding, suggesting no survival benefit for a rhythm-control strategy over rate control in a broad AF population, led to a decade-long paradigm favoring rate control as an initial approach.1 However, cardiovascular medicine has evolved dramatically since the early 2000s, particularly in our understanding and management of heart failure with preserved ejection fraction (HFpEF) and catheter-based therapies for AF.
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DeWald et al. (2025) studied this question.
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