This post is authored by Gregory F. Michaud, MD, FACC, and Roy M. John, MD, FACC. Most patients with atrial fibrillation (AFib) are elderly and symptoms are effectively managed with medications that control the ventricular rate. Anticoagulation should be administered in patients who are at significant risk of stroke (CHADS-VASC ≥ 2-3). Rhythm control, however, may be preferable in some patients. Here are five reasons to choose rhythm control over rate control in treating patients with atrial fibrillation, regardless of whether AFib episodes are paroxysmal or persistent:

1. Symptoms despite reasonable attempts at rate control. A word of caution when evaluating a patient for symptoms – patients with exertional dyspnea, poor exercise tolerance or fatigue may be incorrectly labeled “asymptomatic” in the absence of palpitations.
2. Intolerance to effective rate control medications.
3. Significant diastolic dysfunction. Often these patients do not tolerate AV dysynchrony even when the ventricular rate is well controlled. A classic example is a patient with hypertrophic cardiomyopathy.
4. Tachycardia-related cardiomyopathy and poor response to AV nodal blocking agents.
5. Young patients with persistent or frequent paroxysmal atrial fibrillation.

Don’t miss the free web-based symposium, Rhythm Control:  What Therapy for What Patient? on Thurs., Sept. 27 at 12:00 pm ET. Case examples to illustrate clinical decision pathways and the pros and cons of various therapeutic options will be presented. Visit the joint ACC/Heart Rhythm Society AFib CardioSource Clinical Community for more information.

This blog post is part of a series of blog posts during AFib Awareness Month. Visit ACC’s Facebook page for additional information. The joint ACC/HRS AFib CardioSource Clinical Community is an online community that addresses atrial fibrillation topics that are relevant to routine and advanced practice. The community offers a collaborative space that facilitates interaction between clinical disciplines by offering an article of the month series, videos, case challenges, hot topics and more.

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