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Maintenance of sinus rhythm in atrial fibrillation: Catheter ablation versus antiarrhythmic drug therapy

Author
Rod Passman, MD, MSCE
Section Editors
Bradley P Knight, MD, FACC
N A Mark Estes, III, MD
Deputy Editor
Gordon M Saperia, MD, FACC

INTRODUCTION

For patients with atrial fibrillation (AF), the two principal goals of therapy are symptom control and the prevention of thromboembolism. (See "Hemodynamic consequences of atrial fibrillation and cardioversion to sinus rhythm", section on 'Adverse hemodynamics in AF' and "Atrial fibrillation: Anticoagulant therapy to prevent embolization".)

In asymptomatic or minimally symptomatic patients with AF, there is often no need to pursue aggressive measures to maintain sinus rhythm. For those patients who might feel better in sinus rhythm, rate- and rhythm-control strategies improve symptoms, but neither has been conclusively shown to improve survival compared to the other. The factors determining the choice between these two strategies are discussed elsewhere. (See "Rhythm control versus rate control in atrial fibrillation", section on 'Definitions'.)

For those patients in whom a rhythm control strategy is chosen, catheter ablation or antiarrhythmic drugs are the two principle therapeutic options. (See "Catheter ablation to prevent recurrent atrial fibrillation: Clinical applications" and "Antiarrhythmic drugs to maintain sinus rhythm in patients with atrial fibrillation: Recommendations".)

This topic will compare the efficacy and safety of these two options for rhythm control and provide recommendations for choosing one or the other.

CLASSIFICATION

The following terms are used in the classification of patients with atrial fibrillation (AF). In the studies discussed in this topic, some, but not all, of these groups have been included (see "Overview of atrial fibrillation", section on 'Classification'):

      

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Literature review current through: Nov 2016. | This topic last updated: Wed Sep 21 00:00:00 GMT+00:00 2016.
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