Rate versus rhythm control in atrial fibrillation

Atrial fibrillation (AF) remains an important health and thus economic problem. AF is not only the most commonly encountered arrhythmia in people; it also is associated with considerable morbidity and mortality. The incidence of AF progressively increases in patients with underlying heart disease and in patients with advancing age, making it a typical arrhythmia of the elderly. Aging of the population and the fact that more and more patients survive the sequelae of ischemic, hypertensive, and valvular heart disease make AF even more important. During the last 10 years, insights into the mechanisms underlying AF have increased significantly, and many new treatment modalities, such as catheter ablation, MAZE surgery, internal cardioversion, internal defibrillators, and pacemakers with preventive pacing algorithms have been developed. Despite this, the efforts to restore and maintain sinus rhythm long-term (rhythm control) are often time-consuming and disappointing and carry the risk of proarrhythmia and other adverse effects. On the other hand, accepting the arrhythmia and preventing the rapid ventricular rate during AF (rate control) can be performed in most patients with relative ease and effectiveness.