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While vulnerable to pathological, physiological, and pharmacological stressors, cardiac rhythm control is remarkably constant and robust.
Rhythm control is an important goal in the treatment of recurrent atrial tachyarrhythmias (AT).
These factors include the severity of complaints and how these will affect the individual patients, and the severity of AF, i.e. how successful rhythm control is expected to be.
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Therefore, prospective randomized trials that include catheter ablation and new antiarrhythmic drugs for rhythm control are needed to reaffirm the concept that sinus rhythm maintenance may improve outcome.
38 The probability of rhythm control being more cost-effective than rate control was reportedly <0.01, even at a value of $100,000/QALY gained.
'Rhythm control' was achieved in 50% (n = 56) of patients, 'rate control' in 12% (n = 14) and 38% (n = 43) of patients required prolonged hospital treatment.
38, 39 Thus, in the AFFIRM health economic analysis there was a low probability that rhythm control was more effective in terms of LYG.
The Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study concluded that rhythm control was more costly and less effective than rate control, with an incremental cost difference of $5077 between the two treatment classes.
In our patient, rhythm control was pursued, and in line with current guidelines [ 1], pulmonary vein ablation was indicated after antiarrhythmic drug treatment (with amiodarone) had failed to maintain sinus rhythm.
After 12 months of follow up, 10% in the rate-control group and 56% of the rhythm-control group were in sinus rhythm, and rhythm control was associated with better exercise tolerance (as assessed by 6-min walk test) but increased number of hospitalizations.
Rate or rhythm controls are the two possible methods to manage AF.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com