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Multiple groups have explored whether strategies to maintain sinus rhythm (“rhythm control”) or those focused predominantly on controlling the ventricular rate (“rate control”) — in conjunction with any antithrombotic therapies needed to prevent stroke — are preferable for patients with atrial fibrillation (AF).
A clear-cut advantage for rhythm control has been difficult to demonstrate, but, in 2020, the EAST-AFNET 4 investigators reported results from a trial of 2800 patients (mean age, 70) with “early” AF (diagnosed within 1 year prior to enrollment; median, 36 days) who were randomized to rhythm control (i.e., antiarrhythmic drugs or ablation) or rate control. Anticoagulation medications were common in both groups. After 5 years of follow…