Rhythm Control Therapy

Rhythm control therapy can help to reduce AF-related symptoms, espeically when symptoms persist despite optimal rate control therapy. The most commonly used therapy to maintain sinus rhythm are antiarrhythmic drugs. When these fail, catheter ablation in the left atrium can also be used. In selected patients, catheter ablation without prior antiarrhythmic drug therapy can be considered.

To date, the long-term effectiveness of rhythm control therapy is moderate, and many patients experience recurrent arrhythmia episodes despite such therapy. Nonetheless, rhythm control can help to improve patient symptoms.

Antiarrhythmic Drug Therapy

Antiarrhythmic drugs prevent recurrent AF by modulating cardiac ion channels. The main effects are probably mediated by blocking sodium, potassium, and calcium channels. This ion channel blockade prolongs the atrial action potential and alters atrial conduction. Ion channel blocking drugs (such as Amiodarone, Dronedarone, Flecainide, Propafenone, Sotalol) can thereby terminate AF, especially of recent onset, and help to prevent arrhythmia recurrences.

Catheter Ablation

AF is triggered by electric impulses coming from the pulmonary veins. In some patients, this is the main cause of AF (“focal AF”). Pulmonary vein isolation by catheter ablation can stop the bad impulses and prevent AF. In general, catheter ablation is reserved to patients with AF which remains symptomatic despite optimal medical therapy, including rate and rhythm control.  The procedure requires placement of catheters in the left atrium via the large femoral veins.