Maintaining sinus rhythm with antifibrillatory drugs in atrial fibrillation

Management of atrial fibrillation is a common and complex clinical problem. Two major treatment strategies have emerged: suppression of recurrences versus control of ventricular rate and anticoagulation to reduce the risk of stroke. Maintaining sinus rhythm offers the hemodynamic benefits of improving ventricular performance and exercise capacity but may expose the patient to the risk of proarrhythmia/sudden death and drug-related morbidity. Controlling ventricular rate helps decrease symptomatic palpitations and improve exercise capacity but necessitates long-term anticoagulation (which may also be needed despite the use of antiarrhythmics to suppress recurrences of atrial fibrillation) with some risk of bleeding. Randomized trials are now needed to define the relative benefits of these 2 treatment strategies. Such trials should be designed to provide information on the impact of the 2 approaches on symptoms, exercise capacity, quality of life, and mortality rate in patients with atrial fibrillation.