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. 2013 Apr;2(1):30-5.
doi: 10.15420/aer.2013.2.1.30.

Current Evidence and Recommendations for Rate Control in Atrial Fibrillation

Abhishek Maan  1 , Moussa Mansour  2 , Jeremy N Ruskin  2 , E Kevin Heist  3
Affiliations

Current Evidence and Recommendations for Rate Control in Atrial Fibrillation

Abhishek Maan et al. Arrhythm Electrophysiol Rev. 2013 Apr.

Abstract

Atrial fibrillation (AF) is the most common cardiac arrhythmia encountered in clinical practice, which is associated with substantial risk of stroke and thromboembolism. As an arrhythmia that is particularly common in the elderly, it is an important contributor towards morbidity and mortality. Ventricular rate control has been a preferred and therapeutically convenient treatment strategy for the management of AF. Recent research in the field of rhythm control has led to the advent of newer antiarrhythmic drugs and catheter ablation techniques as newer therapeutic options. Currently available antiarrhythmic drugs still remain limited by their suboptimal efficacy and significant adverse effects. Catheter ablation as a newer modality to achieve sinus rhythm (SR) continues to evolve, but data on long-term outcomes on its efficacy and mortality outcomes are not yet available. Despite these current developments, rate control continues to be the front-line treatment strategy, especially in older and minimally symptomatic patients who might not tolerate the antiarrhythmic drug treatment. This review article discusses the current evidence and recommendations for ventricular rate control in the management of AF. We also highlight the considerations for rhythm control strategy in the management of patients of AF.

Keywords: Atrial fibrillation; beta-blockers; rate control.

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Figures

Figure 1:
Figure 1:. Cumulative Mortality from Any Cause in the Rhythm Control and the Rate Control Group in the AFFIRM Trial
Figure 2:
Figure 2:. A) Time Trends in the Prescription Patterns of Rhythm Control Medications After the Publication of the AFFIRM Trial in a Large Registry of Canadian Patients B) Effect of Rate Control and Rhythm Control Strategies on All-cause Mortality in this Group of Patients
Figure 3:
Figure 3:. Impact of Intensity of Rate Control on Cardiovascular Morbidity and Mortality in an Analysis of the RACE II Trial
See this image and copyright information in PMC

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