Practical Lessons From The New Atrial Fibrillation Guidelines

INTRODUCTION Atrial fibrillation is the most common arrhythmia in the country, and its prevalence is increasing as the U.S. population ages.1 Frequently associated with hypertension and/or coronary artery disease (CAD), atrial fibrillation results in serious morbidity, mortality, hospitalization and emergency room visits. Since 2000, five clinical trials have been published regarding the question of whether the use of long-term prophylactic therapy with antiarrhythmic drugs to maintain sinus rhythm (rhythm control) in patients with atrial fibrillation results in a better outcome than a strategy aimed at controlling heart rate and anticoagulation appropriate to the atrial fibrillation guidelines (rate control).2–6 In all five trials, there was no improvement in clinical outcome (stroke, death, heart failure, hospitalization) in patients comparing the two strategies. It is useful to focus on the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial since it is three-times the size ...