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Atrial fibrillation (AF) can be managed with 1 of 2 strategies. A rhythm-control strategy uses antiarrhythmic drugs to maintain sinus rhythm (SR), with possible eventual discontinuation of anticoagulation. A rate-control strategy allows AF to persist but slows ventricular rate with atrioventricular-nodal blocking agents or ablation of the atrioventricular junction and pacemaker implantation (anticoagulation is continued). In 2 multicenter, randomized trials, researchers compared the 2 strategies.
Researchers in the U.S. and Canada randomized 4060 AF patients (minimum age, 65; mean, 70) to either rhythm control or rate control; in all patients, AF was likely recurrent and warranted treatment, and risk for stroke was high. Rhythm control invol…