ATRIAL-FIBRILLATION - MAINTAINING STABILITY OF SINUS RHYTHM OR VENTRICULAR RATE CONTROL - THE NEED FOR PROSPECTIVE DATA - THE PIAF TRIAL

Atrial fibrillation is one of the most commonly encountered clinical a rrhythmias. Different treatment options for this rhythm disorder exist with the electrical and/or pharmacological cardioversion to sinus rhy thm with subsequent antiarrhythmic drug therapy to prevent recurrences being one of the primary therapeutic goals. Another alternative, howe ver, is represented by the control of the ventricular rate in patients with persistent atrial fibrillation. The question of which of these t wo strategies should be preferred in the majority of patients with atr ial fibrillation has not been studied in a prospective way. Given the background of conflicting data with respect to the prognostic impact o f atrial fibrillation and of the increasing evidence concerning the ri sks of antiarrhythmic drug treatment in atrial fibrillation, a prospec tive multicenter trial has been initiated to compare these two therape utic alternatives prospectively. Patients will be randomly assigned to cardioversion with subsequent antiarrhythmic drug therapy to prevent recurrent atrial fibrillation or to a therapy aiming exclusively at co ntrol of the ventricular rate during persistent atrial fibrillation. A ll patients will receive anticoagulation by means of warfarin (target INR 2.5-3.5) to prevent thromboembolic complications. The rationale an d the design of the PIAF trial (Pharmacological Intervention in Atrial Fibrillation) are discussed below, The pilot phase of this study has begun patient enrollment in the spring of 1995.