Management of atrial fibrillation: focus on rate versus rhythm control

Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults and accounts for approximately one-third of all arrhythmias requiring admission to the hospital. Treatment strategies are determined by the classification of AF, whether paroxysmal or persistent, as well as numerous patient-specific cardiac and medical considerations (eg, pre-existing congestive heart failure or previous myocardial infarction). Thromboembolic risk also influences whether patients are treated with antiplatelet or anticoagulant medications. Several large clinical trials have deemed both rate and rhythm control acceptable treatment strategies for AF. Additionally, nonpharmacologic approaches such as surgical and electroablative options also exist. The clinician must exercise sound clinical judgment when deciding which treatment approach is best suited for a particular patient.