ATRIAL-FIBRILLATION - MAINTENANCE OF SINUS RHYTHM VERSUS RATE CONTROL

Atrial fibrillation represents a common and challenging arrhythmia. A rational approach to management of the individual case depends on care ful assessment of the temporal pattern of the arrhythmia, any associat ed cardiovascular disease, and any particular features suggesting the advisability or risks of any particular treatment regimen. The nature of an arrhythmia and of individual patient factors change over time, r equiring a flexible approach to long-term treatment that may be define d only after months or years. While new treatment options such as cath eter ablation techniques and implantable atrial defibrillators are bei ng tested, old therapies (e.g., low-dose amiodarone) are undergoing re apprisal, increasing recognition of the dangers of antiarrhythmic ther apy used to maintain sinus rhythm is focusing attention on nonpharmaco logic methods. All patients with persistent atrial fibrillation merit serious consideration for direct current cardioversion before acceptin g that atrial fibrillation is permanent, and many patients may benefit from more than one attempt to restore and maintain sinus rhythm.