Clinical review: clinical management of atrial fibrillation - rate control versus rhythm control

Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the critically ill and is associated with adverse outcomes. Although there are plausible benefits from conversion and maintenance of sinus rhythm (the so-called 'rhythm-control' strategy), recent randomized trials have failed to demonstrate the superiority of this approach over the rate-control strategy. Regardless of approach, continuous therapeutic anticoagulation is crucial for stroke prevention. This review addresses the findings of these studies and their implications for clinical management of patients with atrial fibrillation.

Figure 1

Treatment algorithm for atrial fibrillation. ^aConsider anticoagulation and early cardioversion if symptomatic. ^bRefer to Table 5. INR, international normalized ratio; LV, left ventricular.

Figure 2

Risk stratification for anticoagulation treatment. INR, international normalized ratio.