BMJ  2003;326:1411-1412 (28 June), doi:10.1136/bmj.326.7404.1411

Editorial

Persistent atrial fibrillation: rate control or rhythm control

Rate control is not inferior to rhythm control

The first 150 words of the full text of this article appear below.

Atrial fibrillation is the commonest sustained tachyarrhythmia encountered in clinical practice.¹ With an ageing population and improved survival of patients with cardiac disease its prevalence continues to rise.² It is associated with a doubling of overall morbidity and mortality from cardiovascular disease³ and is the most common cause of embolic stroke.⁴ Restoring sinus rhythm holds the theoretical advantage of reducing the risk of thromboembolism and need for anticoagulation and improved haemodynamics and quality of life. However, most current anti-arrhythmic drugs have limited efficacy and several side effects. With the use of anti-arrhythmics and serial electrical cardioversion for early relapse up to 53% of patients are in sinus rhythm at one year,⁵ but only 25% remain so at five years.⁶ Considerable controversy therefore exists as to whether rhythm or rate control is the more appropriate management for most patients with persistent atrial fibrillation. Five recent trials have looked specifically at this . . . [Full text of this article]

(christopherboos@hotmail.com)

Department of Cardiology, Portsmouth Hospitals NHS Trust, Portsmouth PO3 6AD

Department of Internal Medicine II, Klinikum Lippe, D-32756 Detmold, Germany

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Rapid Responses:

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Rate and rhythm are both important in critically ill patients

Egbert Pravinkumar
bmj.com, 27 Jun 2003 [Full text]

Puzzled

Rainer H Burchett
bmj.com, 1 Jul 2003 [Full text]

Re: Puzzled

Andy Evans
bmj.com, 2 Jul 2003 [Full text]

Rate control of atrial fibrillation

Elliot F Epstein
bmj.com, 2 Jul 2003 [Full text]

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