Treatment of Atrial Fibrillation

Objectives. There are two generally accepted strategies for managing atrial fibrillation (AF): rate control and rhythm control. However, within each strategic approach there are a large number of potential pharmacological and nonpharmacological therapies, and the comparative safety and effectiveness of these therapies—both within and between strategies—are uncertain.

Data sources. We searched PubMed®, Embase®, and the Cochrane Database of Systematic Reviews for relevant English-language comparative studies.

Review methods. Two investigators screened each abstract and full-text article for inclusion, abstracted data, rated quality and applicability, and graded evidence. When possible, random- effects models were used to compute summary estimates of effects.

Results. Our review included 182 articles (148 unique studies): 14 studies relevant to rate- control drugs, 3 relevant to strict versus lenient rate control, 6 relevant to rate-control procedures versus drugs in patients for whom initial pharmacotherapy was ineffective, 42 relevant to antiarrhythmic drugs and electrical cardioversion for conversion to sinus rhythm, 83 relevant to rhythm-control procedures and drugs for maintenance of sinus rhythm, and 14 focusing on the comparison of rate- and rhythm-control strategies.    Read more