Rhythm control for management of patients with atrial fibrillation: balancing the use of antiarrhythmic drugs and catheter ablation.
Antiarrhythmic drug (AAD) therapy may be beneficial for patients with symptoms attributable to atrial fibrillation despite adequate rate control. The limited long-term efficacy of AAD and the relatively large proportion of patients discontinuing therapy because of side effects led to the development of nonpharmacological therapies to achieve rhythm control. Pressing questions remain about the effect of ablation therapy on long-term patient outcomes. Based on recent clinical trials and meta-analyses, ablation appears more effective and possibly safer than AAD for long-term maintenance of sinus rhythm in selected patients, but the evidence is insufficient to recommend ablation in preference to drug therapy as the first AAD therapy for the majority of patients in whom a rhythm control strategy is justified. Herein, we review the most current evidence supporting the use of AAD and catheter ablation in atrial fibrillation.
Cardiovascular Institute, Mount Sinai Heart, Mount Sinai School of Medicine, New York, New York, USA. juan.viles-gonzalez@mssm.edu
Juan F
JF
Viles-Gonzalez
Valentin
V
Fuster
Jonathan
J
Halperin
Hugh
H
Calkins
Vivek Y
VY
Reddy
D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects; D019317:Evidence-Based Medicine; D006329:Heart Conduction System / Q000187:drug effects* / Q000503:physiopathology / Q000601:surgery*; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D012008:Recurrence; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents
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