Rhythm control strategy in the transcatheter ablation era

Abstract

The latest ESC guidelines on atrial fibrillation limit rhythm control to symptomatic cases, continuing on the same line that the Affirm and Race trials traced twenty years ago. There is evidence though that rhythm control, net of the adverse effects of the antiarrhythmic drugs, is useful to improve the prognosis beyond just the reduction of symptoms. With transcatheter ablation we can now finally split the clinical benefit of an antiarrhythmic therapy from the negative impact on prognosis of the medical approach, especially in patients with structural heart disease. We must ask ourselves nowadays, in light of the latest trials analyzed in this review, if there is space for a first line rhythm control strategy, if it should be pursued regardless of symptoms, with what modalities and how much in particular the patient with reduced ejection fraction can benefit from it.

Keywords

• atrial fibrillation
• rhythm control
• ablation