Annals On Call Podcast

Atrial Fibrillation: Control Rate or Rhythm

8 snips
Jan 2, 2023
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INSIGHT

Rhythm Control Gains From Ablation

  • Early trials showed no difference between rate and rhythm control but had major caveats like limited ablation use.
  • Recent ablation trials show reduced AF burden and mortality benefit when sinus rhythm is maintained.
INSIGHT

Ablation Focus And Burden Threshold

  • Pulmonary vein isolation has been the cornerstone of AF ablation since the late 1990s and techniques evolved around the posterior wall.
  • Ablation need not eliminate AF completely; reducing burden below ~50% yields clinical benefit.
ADVICE

Match Early-Diagnosis Criteria

  • The Korean study limited participants to new users of rate or rhythm therapies diagnosed within one year to match EAST-AFNET 4 criteria.
  • Use early diagnosis (within one year) as a key inclusion when comparing rhythm versus rate strategies.
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