Appropriate outcome measures in trials evaluating treatment of atrial fibrillation

Background Atrial fibrillation [AF] is a widespread disease chat has only r ecently received the focused attention of arrhythmia specialists despite be ing the most frequently occurring significant cardiac arrhythmia. Methods and Results The wide variety of trial designs used to evaluate AF t reatment is a reflection of the diverse outcomes associated with this condi tion. The best trials assess the impact of treatment on a clearly measured outcome that is of clinical relevance to patients. This review discusses th e different designs of AF treatment trials and analyzes the utility of the various outcomes that can be assessed. Conclusions A sensible goal of AF treatment is to reduce the frequency of r ecurrences and to prolong the time between them. The most appropriate trial s focus on AF recurrences that are symptomatic and therefore relevant to th e patient. We still do not know if there is value in AF prevention, beyond preventing symptoms. However, ongoing and future studies will show whether AF suppression reduces the longer-term risks of stroke or death and improve s patient quality of life. Cost of care will increasingly be studied in fut ure trials of AF management.