Consideration should be given to whether rhythm control or rate control is best when treating patients with atrial fibrillation.
- The management of patients with atrial fibrillation (AF) may be considered at two levels: rhythm control versus rate control; and the protection against stroke and embolic events.
- Rhythm control may be achieved through antiarrhythmic drugs such as flecainide, sotalol or amiodarone; however, it may be limited by efficacy, tolerance and proarrhythmia.
- Catheter ablation for AF may provide long-term freedom from AF in the absence of antiarrhythmic medication and is most effective in patients with paroxysmal AF in the absence of structural heart disease.
- Rate control may be achieved through atrioventricular nodal blocking medications or pacemaker implant followed by atrioventricular node ablation.