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Perspectives

Atrial fibrillation: rhythm versus rate control

Peter Kistler

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Abstract

Consideration should be given to whether rhythm control or rate control is best when treating patients with atrial fibrillation.

Key Points

  • 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.

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