Cabins, castles, and constant hearts: rhythm control therapy in patients with atrial fibrillation

Stephan Willems, Christian Meyer, Joseph de Bono, Axel Brandes, Lars Eckardt, Arif Elvan, Isabelle van Gelder, Andreas Goette, Michele Gulizia, Laurent Haegeli, Hein Heidbuchel, Karl Georg Haeusler, Josef Kautzner, Lluis Mont, G Andre Ng, Lukasz Szumowski, Sakis Themistoclakis, Karl Wegscheider, Paulus Kirchhof

Research output: Contribution to journalArticlepeer-review

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Abstract

Recent innovations have the potential to improve rhythm control therapy in patients with atrial fibrillation (AF). Controlled trials provide new evidence on the effectiveness and safety of rhythm control therapy, particularly in patients with AF and heart failure. This review summarizes evidence supporting the use of rhythm control therapy in patients with AF for different outcomes, discusses implications for indications, and highlights remaining clinical gaps in evidence. Rhythm control therapy improves symptoms and quality of life in patients with symptomatic AF and can be safely delivered in elderly patients with comorbidities (mean age 70 years, 3-7% complications at 1 year). Atrial fibrillation ablation maintains sinus rhythm more effectively than antiarrhythmic drug therapy, but recurrent AF remains common, highlighting the need for better patient selection (precision medicine). Antiarrhythmic drugs remain effective after AF ablation, underpinning the synergistic mechanisms of action of AF ablation and antiarrhythmic drugs. Atrial fibrillation ablation appears to improve left ventricular function in a subset of patients with AF and heart failure. Data on the prognostic effect of rhythm control therapy are heterogeneous without a clear signal for either benefit or harm. Rhythm control therapy has acceptable safety and improves quality of life in patients with symptomatic AF, including in elderly populations with stroke risk factors. There is a clinical need to better stratify patients for rhythm control therapy. Further studies are needed to determine whether rhythm control therapy, and particularly AF ablation, improves left ventricular function and reduces AF-related complications.

Original languageEnglish
Article numberehz782
Pages (from-to)3793-3799c
Number of pages10
JournalEuropean Heart Journal
Volume40
Issue number46
Early online date22 Nov 2019
DOIs
Publication statusPublished - 22 Nov 2019

Keywords

  • atrial fibrillation
  • rhythm control therapy
  • AF ablation
  • antiarrhythmic drugs
  • heart failure
  • stroke
  • mortality

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