We searched MEDLINE, PubMed, and major conference proceedings with the search terms “atrial fibrillation”, “rhythm control”, “cardioversion”, “antiarrhythmic”, and “catheter ablation”. We also searched proccedings from the American Heart Association Scientific Sessions, American College of Cardiology, European Society of Cardiology, Heart Rhythm Society, and Cardiostim Scientific Sessions. Finally, guideline documents about management of atrial fibrillation across major cardiovascular societies
SeriesRhythm control in atrial fibrillation
Section snippets
Reasons to choose a rhythm control strategy
Atrial fibrillation affects 33 million individuals worldwide,1 and increases risk of stroke, heart failure, and death, and also impairs quality of life. Accordingly, the goals of care in atrial fibrillation include the prevention of stroke, control of the ventricular rate, and minimisation of symptoms to improve quality of life.2, 3, 4 Although some patients' symptoms are relieved with ventricular rate control alone, many require restoration and maintenance of sinus rhythm—referred to as rhythm
Acute rhythm management for atrial fibrillation
The acute evaluation and management of patients presenting with atrial fibrillation is mainly focused on the improvement of cardiac haemodynamics and the provision of protection against thromboembolic events, such as stroke and systemic embolism. Both inappropriately tachycardic ventricular rates and irregularity of the cardiac rhythm can lead to symptoms or haemodynamic impairment, particularly in patients with abnormal ventricular filling (eg, diastolic function). The severity of atrial
Antiarrhythmic drugs to maintain sinus rhythm
When atrial fibrillation recurs and impairs quality of life, rhythm control is needed to restore and maintain sinus rhythm. There is no evidence that antiarrhythmic drug treatment improves survival and neither rate nor rhythm control strategies have been shown to be superior to one another. Thus, the focus of rhythm control with antiarrhythmic treatment is on symptom control and improvement of quality of life. Oral drug treatment is considered first-line therapy for long-term outpatient rhythm
Indications and patient selection
After the discovery of ectopic impulses that initiate atrial fibrillation,42, 43 catheter ablation was developed to isolate and eliminate ectopic triggers of atrial fibrillation or modify the susceptible atrial substrate. There have been many improvements in the safety and efficiency of catheter ablation for atrial fibrillation management in the last decade.44 In terms of maintenance of sinus rhythm, catheter ablation is more effective than antiarrhythmic drug therapy in selected patients with
Heart failure
When rhythm and rate control strategies are compared in patients with atrial fibrillation and heart failure with reduced ejection fraction, neither strategy has been found to lead to superior outcomes.86 Efforts to restore and maintain sinus rhythm are particularly challenging in patients with heart failure.86 However, patients with heart failure who have less atrial fibrillation suffer less severe functional impairment and restoration of sinus rhythm after catheter ablation leads to improved
Conclusion
Rhythm control therapy to maintain sinus rhythm is an important component of arrhythmia management in patients with atrial fibrillation. Although neither ventricular rate nor rhythm control has been established as superior, rhythm control is an important strategy to improve symptoms, functional status, and quality of life in patients with atrial fibrillation. Antiarrhythmic drug therapy remains a first-line treatment for maintenance of sinus rhythm. Catheter ablation leads to improved outcomes
Search strategy and selection criteria
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Cited by (103)
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2023, Indian Pacing and Electrophysiology JournalInvestigation of the arcane inhibition of human organic anion transporter 3 by benzofuran antiarrhythmic agents
2021, Drug Metabolism and PharmacokineticsCitation Excerpt :As AFib predisposes the body to thrombogenesis [12], cornerstones in the management of AFib include anticoagulation and rhythm control [11]. Pertaining to the latter, antiarrhythmic agents such as amiodarone and dronedarone are commonly used as rhythm control agents [13]. Notably, amiodarone, dronedarone and their respective major pharmacologically-active metabolites, N-desethylamiodarone (NDEA) [14] and N-desbutyldronedarone (NDBD) [15] share a similar benzofuran chemical scaffold (Fig. 1B–E).
Elective cardioversion at a district general hospital: a retrospective evaluation of outcomes
2024, British Journal of Nursing