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(Circulation. 2005;111:3150-3156.)
© 2005 American Heart Association, Inc.

Controversies in Cardiovascular Medicine

An Argument for Maintenance of Sinus Rhythm in Patients With Atrial Fibrillation

Peter Zimetbaum, MD

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

	Introduction

 
The age-old and common-sense argument that if you were born in sinus rhythm you should probably try to remain so has seemingly lost some vigor with the results of recent randomized studies.^1–6 These trials have convincingly demonstrated that in a select population of patients, a strategy of rhythm control with antiarrhythmic drugs confers no mortality benefit over a rate-control strategy. These studies have also demonstrated no quality-of-life benefit associated with a strategy of maintenance of sinus rhythm in this patient population.

The question therefore remains, is there any reason to maintain sinus rhythm? The answer is "yes," given the fundamental observation that atrial fibrillation (AF) is an independent predictor of mortality in virtually every study that has monitored this end point.^7–13 Unselected population-based studies (most notably, the Framingham Heart Study) have identified an increased mortality risk associated with AF, particularly in women.¹⁴ The Centers for Disease Control and Prevention analyzed national and state mortality statistics for patients with AF in 1999.¹⁵ They identified 67 875 deaths in which AF was a contributing cause, with an age-adjusted death rate of 24.7/100 000 population. Patients aged 75 years represented 84% of these deaths and those aged 85 years represented 47.4%. Studies of selected populations with coronary and noncoronary cardiomyopathy, congestive heart failure, hypertrophic obstructive cardiomyopathy, and sinoatrial dysfunction have all demonstrated an increased mortality risk associated with AF.^7–13

The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study, the largest of the recent trials of rhythm control compared with rate control, demonstrated . . . [Full Text of this Article]

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				V. Essebag, M. R. Reynolds, T. Hadjis, R. Lemery, B. Olshansky, A. E. Buxton, M. E. Josephson, and P. Zimetbaum Sex Differences in the Relationship Between Amiodarone Use and the Need for Permanent Pacing in Patients With Atrial Fibrillation Arch Intern Med, August 13, 2007; 167(15): 1648 - 1653. [Abstract] [Full Text] [PDF]