This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Falk, R. H. Search for Related Content PubMed PubMed Citation Articles by Falk, R. H. Related Collections Other Treatment Arrhythmias, clinical electrophysiology, drugs

(Circulation. 2005;111:3141-3150.)
© 2005 American Heart Association, Inc.

Controversies in Cardiovascular Medicine

Is rate control or rhythm control preferable in patients with atrial fibrillation?

Rate Control Is Preferable to Rhythm Control in the Majority of Patients With Atrial Fibrillation

Rodney H. Falk, MD, FRCP

From Harvard Vanguard Medical Associates (R.H.F.), Boston, Mass, and Beth Israel Deaconess Medical Center (P.Z.), Boston, Mass.

Reprint requests to Rodney H. Falk, MD, Harvard Vanguard Medical Associates, 133 Brookline Ave, Boston, MA 02215 (e-mail rfalk@partners.org); or Peter Zimetbaum, MD, Beth Israel Deaconess Medical Center, 185 Pilgrim Rd, Boston, MA 02215 (e-mail pzimetba@BIDMC.harvard.edu).

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 

"...but to his surprise — the more he looked — the more Piglet wasn’t there."

— A.A. Milne, The House at Pooh Corner

The management of patients with atrial fibrillation has been the subjects of intense investigation over the past 2 decades. In the 1980s and early 1990s, large clinical trials of anticoagulant therapy for stroke prevention were performed. These consistently demonstrated that atrial fibrillation confers a significant and ongoing stroke risk and that anticoagulant therapy significantly reduces this risk.^1–10 Warfarin subsequently became a standard of therapy for patients with atrial fibrillation, whether paroxysmal, persistent, or permanent.

If patients with atrial fibrillation had a high stroke risk compared with those in sinus rhythm, then logic appeared to dictate that restoration and maintenance of sinus rhythm should reduce the likelihood of thromboembolism and hence obviate the need for long-term warfarin anticoagulation. Perhaps driven in part by this belief, new atrial antiarrhythmic drugs were introduced during this period, and there was an increasing use of such drugs among patients with atrial fibrillation.¹¹ A decade after the trials of anticoagulation in atrial fibrillation, several international trials were implemented to determine whether heart rate control would result in a similar outcome to the outcome after a strategy of restoration and maintenance of sinus rhythm.^12–15 Analysis of these trials demonstrated no benefit either in mortality or in a combined end point of mortality and morbidity. These results are generally interpreted as showing that either rate control or rhythm control is a suitable strategy in a . . . [Full Text of this Article]

This article has been cited by other articles:

				T. G. Brott Novel Approaches to Stroke Prevention in Atrial Fibrillation: Introduction Stroke, February 1, 2007; 38(2): 614 - 614. [Full Text] [PDF]

				E. P. Gerstenfeld Does Rhythm Control Improve Functional Status in Patients With Atrial Fibrillation? J. Am. Coll. Cardiol., November 15, 2005; 46(10): 1900 - 1901. [Full Text] [PDF]