Perspective:

A sinus rhythm strategy using AADs has not been shown to improve outcomes in patients with AF and CHF. The positive results of the current study are likely related to the fact that catheter ablation restores sinus rhythm more effectively than AADs, and that it does so without proarrhythmia and end-organ toxicity. Since rate control was optimized prior to ablation, this makes it unlikely that ventricular dysfunction was due to tachycardia. The results of this small study have possibly far-reaching implications, such as reducing CHF-related hospitalizations, candidacy for implantable defibrillator therapy, and perhaps overall mortality. Whether sinus rhythm and its salutatory effects will be maintained long-term require additional study. Although these results are possible at experienced centers, the complexity of the ablation procedure(s) for persistent AF in this population makes it difficult to generalize these findings.