Treating atrial fibrillation: rhythm control or rate control

Atrial fibrillation (AF), a rhythm characterized by disorganized depolarization of the atria, is frequently encountered in the clinical setting. This dysrhythmia significantly impacts hemodynamics, exercise tolerance, and quality of life. Many factors contribute to this complex dysrhythmia, ultimately leading to electrical and mechanical remodeling. Rhythm control has been the initial treatment choice for AF. However, until recently, differences in outcomes associated with rhythm control versus rate control for AF were unknown. Data from recent clinical trials suggest that rate control is equivalent to rhythm control in terms of mortality. In the rhythm-control group compared to the rate-control group, there was a tendency for increased hospitalizations and medication reactions (although these differences were not significant). Anticoagulation remains an important component of therapy when treating AF, but continues be to inadequately prescribed. Further, INRs commonly are not maintained in a therapeutic range. Finally, the results of the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM), Pharmacological Intervention in Atrial Fibrillation (PIAF), and the Comparison of Rate Control and Rhythm Control in Patients with Recurrent Persistent Atrial Fibrillation (RACE) trials provide guidance in treatment strategies for AF.