Rhythm or rate control in persistent atrial fibrillation

Selecting appropriate treatment strategies for patients with persistent atrial fibrillation has often proved to be a quandary. Foregoing any debate on anticoagulant therapy, the remaining issue is whether the ultimate goal should be achieving and maintaining sinus rhythm or simply controlling the ventricular response during ongoing atrial fibrillation. Since atrial fibrillation affects 5% of the population over the age of 60 and increases with advanced age, it is a question of utmost clinical relevance [1] . Atrial fibrillation may be classified as paroxysmal, persistent, or chronic. Paroxysmal atrial fibrillation can be defined as AF which is self-limited, converting spontaneously to sinus rhythm; persistent AF is defined as necessitating an electrical or chemical cardioversion; whereas permanent or chronic AF does not respond to these maneuvers. For the purposes of this article, the focus will be on the treatment of persistent atrial fibrillation, as it is the subset which most often will require interventions to restore and maintain sinus rhythm.