Rhythm management in atrial fibrillation: less is more.

The management of heart rhythm as part of the treatment of atrial fibrillation (AF) has been the subject of intensive investigation over the past two decades. Until recently, most physicians have believed that the initial approach to rhythm management should give primary consideration to restoration and maintenance of sinus rhythm (SR) (1). The potential benefits of restoration and maintenance of SR include, among others, relief of symptoms, improved exercise tolerance, prevention of stroke, less need for anticoagulant therapy, improved hemodynamic function, and prevention of tachycardia-induced cardiomyopathy (2). The negative aspects of this approach include the rather poor efficacy of the antiarrhythmic drugs (3) and the potential of these drugs to cause adverse effects, including death (4). The