Clinical outcomes following rhythm control for atrial fibrillation: is early better?

Expert Rev Cardiovasc Ther. 2021 Apr;19(4):277-287. doi: 10.1080/14779072.2021.1902307. Epub 2021 Apr 13.

Abstract

Introduction: An integral aspect of atrial fibrillation (AF) management involves better symptom control, incorporating a rate control, rhythm control, or a combination strategy. The 2020 ESC Guidelines suggest that rhythm control strategy should be recommended for symptomatic patients, to mitigate their symptoms and improve the quality of life. However, adequately powered randomized control trials and prospective 'real-world' registries are needed to fully assess the impact of early rhythm control strategies on clinical outcomes in patients with AF.Objective: In this narrative review, we discuss clinical outcomes following rhythm management approach among patients with AF, considering the effectiveness of an early intervention strategy.Expert opinion: Patients involvement and shared decision-making are crucial when deciding the optimal management strategy among patients with AF. For those with newly diagnosed symptomatic AF, an early invasive approach such as catheter ablation may have a role in preventing AF progression and subsequent pathophysiological changes.

Keywords: Atrial fibrillation; cardioversion; catheter ablation; heart failure; rate control; rhythm control.

Publication types

  • Review

MeSH terms

  • Atrial Fibrillation / physiopathology*
  • Catheter Ablation
  • Humans
  • Quality of Life*
  • Randomized Controlled Trials as Topic