Atrial fibrillation: Rate control or rhythm control?

Article Figures & Data

TABLE 1

Treatments for atrial fibrillation

Treatment	Indications	Contraindications
Rate control	Asymptomatic atrial fibrillation and rhythm control not favored (elderly patient, long-standing atrial fibrillation, markedly enlarged left atrium)	Avoid calcium channel blockers in patients with heart failure
Electric cardioversion	Symptomatic atrial fibrillation New-onset atrial fibrillation Low risk of thromboembolism: (< 48 hours since onset of atrial fibrillation, or at least 3 weeks of anticoagulation, or transesophageal echocardiography to rule out thrombus)	No anticoagulation or inability to obtain transesophageal echocardiography
Antiarrhythmic medications	Younger patient High cardiovascular risk Heart failure Failure of rate control therapy	Avoid propafenone and flecainide in those with structural heart disease and coronary heart disease Avoid dronedarone in persistent atrial fibrillation and congestive heart failure Avoid sotalol and dofetilide in renal failure
Catheter ablation	Younger patients Symptomatic atrial fibrillation, refractory to medical therapy Can be considered in heart failure	Marked left atrial dilation
Atrioventricular junction ablation and cardiac resynchronization therapy	Contraindication to ablation or failure of ablation Permanent atrial fibrillation Systolic heart failure with ejection fraction < 30%	Frail patient Expected survival < 1 year