Cardiac rhythm management of patients with atrial fibrillation

Cardiac rhythm management of patients with atrial fibrillation. Cardiac rhythm management of atrial fibrillation (AF) is essential to improve symptoms as well as outcomes in patients with AF; this can be achieved either by rhythm or rate control strategies. Many studies published between 2000 and 2010 have supported the point that these two strategies were both acceptable therapeutic options (without clear superiority of one to the other), even in heart failure patients, pinpointing the side effects and the lack of efficacy of many antiarrhythmic pharmacological drugs. Nevertheless, many patients remain symptomatic despite adequate ventricular rate control and eventually require sinus rhythm restoration and maintenance. Then, rhythm control options have evolved and now include catheter ablation either by radiofrequency or cryotherapy, which allow maintaining sinus rhythm and reduce AF-associated symptoms more reliably than antiarrhythmic drugs, particularly in younger patients. Furthermore, interest in rhythm control by catheter ablation has been reinvigorated by the results of recently published trials, especially in patients with heart failure. However, the impact of catheter ablation on morbidity and mortality have still to be proven before considering it in asymptomatic patients.