Clinical outcomes following rhythm control for atrial fibrillation: is early better?

ABSTRACT

Introduction: An integral aspect of atrial fibrillation (AF) management involves better symptom control, incorporating a rate control, rhythm control, or a combination strategy. The 2020 ESC Guidelines suggest that rhythm control strategy should be recommended for symptomatic patients, to mitigate their symptoms and improve the quality of life. However, adequately powered randomized control trials and prospective ‘real-world’ registries are needed to fully assess the impact of early rhythm control strategies on clinical outcomes in patients with AF.

Objective: In this narrative review, we discuss clinical outcomes following rhythm management approach among patients with AF, considering the effectiveness of an early intervention strategy.

Expert opinion: Patients involvement and shared decision-making are crucial when deciding the optimal management strategy among patients with AF. For those with newly diagnosed symptomatic AF, an early invasive approach such as catheter ablation may have a role in preventing AF progression and subsequent pathophysiological changes.

KEYWORDS:

• Atrial fibrillation
• cardioversion
• catheter ablation
• heart failure
• rate control
• rhythm control

Article highlights

• Highly individualized therapy and shared decision-making are crucial when deciding the optimal management strategy among patients with AF.

• Rhythm control strategy should be considered for symptomatic patients, to mitigate the symptoms and improve quality of life.

• Early rhythm control strategy, incorporated into holistic AF care, may prevent AF progression and improve outcomes among selected patients with newly diagnosed AF.

• Further randomized control trials and ‘real world’ registries are needed to assess the impact of early rhythm control strategy on long-term clinical outcomes in patients with AF.

Declaration of interest

G Lip is a consultant for Bayer/Janssen, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Novartis, Verseon and Daiichi-Sankyo. Speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo. No fees are directly received personally. D Gupta has received institutional research grants from Boston Scientific, Medtronic and Biosense Webster, and personal advisory fees from Boehringer Ingelheim, Boston Scientific and Abbott. D Wright has received research grants and consultancy fees from Boston Scientific and Medtronic.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Disclosures statement

No potential conflict of interest was reported by the author(s).