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Europace Advance Access originally published online on September 14, 2006
Europace 2006 8(11):943-949; doi:10.1093/europace/eul107
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

ATRIAL FIBRILLATION

The progressive nature of atrial fibrillation: a rationale for early restoration and maintenance of sinus rhythm

Isabelle C. Van Gelder* and Martin E.W. Hemels

Department of Cardiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting young as well as elderly patients and presenting a major therapeutic challenge for clinical cardiologists. Recent research has elucidated the progressive nature of AF, including the structural and electrical remodelling that may become manifest if normal sinus rhythm is not restored, and the serious morbidities associated with long-term disease. The controversy over the merits of ventricular rate control vs. the restoration and maintenance of normal sinus rhythm in the treatment of AF has been explored in a number of large-scale, randomized clinical trials. The results of these trials suggest that whereas the two strategies may be equivalent for some patient populations, with both approaches requiring accompanying anticoagulation therapy, the restoration and maintenance of sinus rhythm provide important haemodynamic as well as subjective benefits not afforded by rate control. Although early intervention to limit the progression of this arrhythmia is hindered by the limitations of existing anti-arrhythmic therapies, it is nevertheless a critical goal.

Key Words: Atrial fibrillation, Anti-arrhythmic therapy, Normal sinus rhythm, Catheter ablation

* Corresponding author. Tel: +31 503 612 355; fax: +31 503 614 391. E-mail address: i.c.van.gelder{at}thorax.umcg.nl


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