beta-blockers for atrial fibrillation: must we consider asymptomatic arrhythmias?

Atrial fibrillation (AF) affects more than 5% of the U.S. population .65 years, and 10% of those .80 years of age, making it the most common arrhythmia requiring treatment. Efforts to treat with ablation or devices show promise, but to date, pharmacologic therapy represents the mainstay of AF treatment. The benefit of efforts to control the rhythm (as opposed to rate control with anticoagulation) is debated, and mortality benefit may be clarified by the ongoing AFFIRM trial; nevertheless, most physicians remain committed to reducing symptoms through restoration and maintenance of sinus mechanism. Generally, the agents employed to stabilize the atria are the drugs in the Vaughan Williams categories of class IA, IC and III. In this issue of the Journal, Kühlkamp et al. (1) present data that show beta-adrenergic blockade also acts to reduce the frequency of symptomatic AF.