title: Rationale and current perspective for early rhythm control therapy in atrial fibrillation.
abstract: Atrial fibrillation (AF) is the most common sustained arrhythmia and an important source for mortality and morbidity on a population level. Despite the clear association between AF and death, stroke, and other cardiovascular events, there is no evidence that rhythm control treatment improves outcome in AF patients. The poor outcome of rhythm control relates to the severity of the atrial substrate for AF not only due to the underlying atrial remodelling process but also due to the poor efficacy and adverse events of the currently available ion-channel antiarrhythmic drugs and ablation techniques. Data suggest, however, an association between sinus rhythm maintenance and improved survival. Hypothetically, sinus rhythm may also lead to a lower risk of stroke and heart failure. The presence of AF, thus, seems one of the modifiable factors associated with death and cardiovascular morbidity in AF patients. Patients with a short history of AF and the underlying heart disease have not been studied before. It is fair to assume that abolishment of AF in these patients is more successful and possibly also safer, which could translate into a prognostic benefit of early rhythm control therapy. Several trials are now investigating whether aggressive early rhythm control therapy can reduce cardiovascular morbidity and mortality and increase maintenance of sinus rhythm. In the present paper we describe the background of these studies and provide some information on their design.
authors.affiliation: Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. i.c.van.gelder@thorax.umcg.nl
authors.forename: Isabelle C
authors.initials: IC
authors.lastname: Van Gelder
authors.forename: Laurent M
authors.initials: LM
authors.lastname: Haegeli
authors.forename: Axel
authors.initials: A
authors.lastname: Brandes
authors.forename: Hein
authors.initials: H
authors.lastname: Heidbuchel
authors.forename: Etienne
authors.initials: E
authors.lastname: Aliot
authors.forename: Josef
authors.initials: J
authors.lastname: Kautzner
authors.forename: Lukasz
authors.initials: L
authors.lastname: Szumowski
authors.forename: Lluis
authors.initials: L
authors.lastname: Mont
authors.forename: John
authors.initials: J
authors.lastname: Morgan
authors.forename: Stephan
authors.initials: S
authors.lastname: Willems
authors.forename: Sakis
authors.initials: S
authors.lastname: Themistoclakis
authors.forename: Michele
authors.initials: M
authors.lastname: Gulizia
authors.forename: Arif
authors.initials: A
authors.lastname: Elvan
authors.forename: Marcelle D
authors.initials: MD
authors.lastname: Smit
authors.forename: Paulus
authors.initials: P
authors.lastname: Kirchhof
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000628:therapy*; D017115:Catheter Ablation; D006801:Humans; D012307:Risk Factors; D055502:Secondary Prevention / Q000639:trends*; D020521:Stroke / Q000517:prevention & control; D013923:Thromboembolism / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents