title: [Current management of atrial fibrillation: rhythm or rate control and thoughts about a new treatment paradigm].
abstract: Over the past 30 years, treatment paradigms for atrial fibrillation (AF) patients have changed dramatically. Before 1989, and the publication of the CAST trial results, the primary objective was to maintain or restore sinus rhythm. In the following 20 years, the management of AF patients has focused on the prevention of thrombo-embolic events (with the confrontation of aspirin and oral anticoagulants), and on the debate between rhythm control and rate control. In 2010, the objectives are to reduce symptoms and improve quality of life, to prevent thrombo-embolic complications, and, if possible, to reduce mortality. New anticoagulants will soon be available. Ablative techniques are becoming current practice in selected patients, and the new antiarrhythmic agent dronedarone has shown remarkable clinical results in the ATHENA trial. Overall, ablative techniques can be used in younger patients with paroxysmal or persistent AF refractory to medical treatment a rate control strategy is appropriate in permanent AF, or as second line treatment in patients with other forms of AF.
authors.affiliation: CHRU de Lille - Hôpital Cardiologique, France. salem.kacet@chru-lille.fr
authors.forename: S
authors.initials: S
authors.lastname: Kacet
mesh_terms: D001281:Atrial Fibrillation / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D006339:Heart Rate; D006801:Humans