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Updated: May 7, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Addressing the controversy of rate-versus-rhythm control in atrial fibrillation
Tahmeed Contractor1, Vadim Levin, Ravi Desai
1The Division of Cardiology, Lehigh Valley Health Network, Allentown, PA/University of South Florida Morsani College of Medicine, Tampa, FL.
Insights
Atrial fibrillation management is debated. While rate control and rhythm control show similar outcomes, successful rhythm restoration, especially with radiofrequency ablation, may reduce mortality and is reconsidered for patient subgroups.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Atrial fibrillation is a common arrhythmia linked to stroke, cardiomyopathy, and mortality.
- The optimal management strategy, rate versus rhythm control, remains debated despite numerous comparative trials.
- Previous trials showed no definitive benefit of one strategy over the other, with limitations in antiarrhythmic drug (AAD) efficacy and safety.
Purpose of the Study:
- To re-evaluate the role of rhythm control in atrial fibrillation management.
- To assess the effectiveness of radiofrequency ablation (RFA) compared to antiarrhythmic drugs (AADs) for maintaining sinus rhythm.
- To inform treatment decisions for specific patient subgroups with atrial fibrillation.
Main Methods:
- Review of clinical trials comparing rate and rhythm control strategies in atrial fibrillation.
- Analysis of sub-studies examining outcomes of successful sinus rhythm restoration.
- Evaluation of prospective randomized studies on radiofrequency ablation (RFA) for atrial fibrillation.
Main Results:
- Sub-analyses indicate that successful rhythm control, achieving sinus rhythm, significantly reduces patient mortality.
- Radiofrequency ablation (RFA) shows promise as an effective method for maintaining sinus rhythm compared to AADs.
- RFA has demonstrated good treatment results with acceptable risk in recent studies.
Conclusions:
- Limitations in pharmacologic rate and rhythm control studies necessitate reconsideration of rhythm control.
- Radiofrequency ablation (RFA) offers a promising alternative for rhythm control in atrial fibrillation.
- Rhythm control should be reconsidered as a primary strategy for managing specific atrial fibrillation patient subgroups.
Abstract:
Atrial fibrillation is the most common sustained cardiac arrhythmia and significantly increases patient risk of stroke, cardiomyopathy, and mortality. Rate versus rhythm control as the "best" treatment strategy remains an issue of considerable, ongoing debate. A multitude of clinical trials have compared the 2 strategies and have not shown any benefit of one approach over the other. However, the trials were conducted in specific subgroups of patients and demonstrated low success rates with antiarrhythmic drug (AAD) therapy and a high incidence of adverse AAD effects. Sub-analyses of the trials have confirmed that successful rhythm control with sinus rhythm restoration is associated with a significant reduction in patient mortality. More recently, radiofrequency ablation (RFA) has emerged as a relatively effective procedure for maintaining sinus rhythm compared with use of AADs. Prospective randomized studies have shown good treatment results after the use of RFA, with acceptable risk. Given the limitation of pharmacologic rate versus rhythm control studies, and the promise of RFA, rhythm control should again be reconsidered as the "best" approach for managing many subgroups of patients with atrial fibrillation.
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