Document Detail

Implication from randomized trials of rate and rhythm controls on management of patients with persistent atrial fibrillation.
MedLine Citation:
PMID:  16630092     Owner:  NLM     Status:  MEDLINE    
Recently, several randomized trials were published on the issue of rate or rhythm control for patients with atrial fibrillation (AF). Patients were typically minor symptomatic, relatively old, with age above 70, presenting with a recurrence of AF and suffering from only mild to moderate underlying heart disease. The main outcome of these trials is that rate control is not inferior to rhythm control for the management of patients with AF concerning morbidity and mortality. Also patients' quality of life did not differ significantly in follow-up in these trials. However, rhythm control is not redundant in the treatment of AF. Focus is now on subgroups of patients who could still have benefit being in sinus rhythm. For severely symptomatic patients, patients presenting with the first episode of AF and probably those with severe congestive heart failure, to restore and maintain sinus rhythm should still be the goal. With the failure of antiarrhythmic therapy, nonpharmacological approaches such as pulmonary vein isolation can be performed. Another finding of the randomized trials is that being in sinus rhythm does not prevent from the occurrence of thromboembolic complications. This means that for patients with AF, with risk factors for thromboembolic events, adequate anticoagulant therapy is indicated irrespective of the current heart rhythm. As with antiarrhythmic therapy, the search for new and safer anticoagulant therapy is underway. This review will focus on the key aspects we have learned from the randomized trials on rate and rhythm controls for patients with AF.
Vincent E Hagens; Dirk J Van Veldhuisen; Harry J G M Crijns; Isabelle C van Gelder
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc     Volume:  11     ISSN:  1082-720X     ISO Abbreviation:  Ann Noninvasive Electrocardiol     Publication Date:  2006 Apr 
Date Detail:
Created Date:  2006-04-24     Completed Date:  2006-06-02     Revised Date:  2008-03-10    
Medline Journal Info:
Nlm Unique ID:  9607443     Medline TA:  Ann Noninvasive Electrocardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  170-86     Citation Subset:  IM    
Department of Cardiology, University Medical Center Groningen, the Netherlands.
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MeSH Terms
Anti-Arrhythmia Agents / therapeutic use
Anticoagulants / therapeutic use
Atrial Fibrillation / physiopathology*,  prevention & control*
Electric Countershock
Heart Conduction System / drug effects,  physiopathology
Heart Rate / drug effects,  physiology*
Quality of Life
Randomized Controlled Trials as Topic
Risk Factors
Reg. No./Substance:
0/Anti-Arrhythmia Agents; 0/Anticoagulants

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