Atrial fibrillation and congestive heart failure: should we aim to control the heart's rate or its rhythm?

Abstract

The Atrial Fibrillation and Congestive Heart Failure trial, which was conducted in patients with a reduced left ventricular ejection fraction, demonstrates that prognosis is independent of whether treatment is targeted towards controlling the heart's rate or its rhythm. The study also showed that other factors, such as use of β-blockers, angiotensin-converting-enzyme inhibitors, angiotensin-receptor blockers, oral anticoagulants, and implantable cardioverter-defibrillators, can have a major influence on prognosis. Antiarrhythmic drugs (primarily amiodarone) were well tolerated, and adequate rate control was achieved with adjusted doses of β-blockers combined with digoxin. Future studies should focus on the clinical importance of radiofrequency ablation for atrial fibrillation, versus that of traditional approaches to treatment.