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Cardiologists often talk about 2 fundamental approaches to treating Afib which are called a rate control strategy or a rhythm control strategy.

The essential difference between these 2 is that in rate control strategy, the goal is not to obtain or maintain normal rhythm but simply to prevent the heart rate from going too fast.

In rhythm control, the goal is to keep the patient in sinus rhythm.

In this video, we are going to focus on a rhythm control strategy.

While a rate control strategy can make the most sense for many patients with Afib, there are cardiologists who feel that most patients would benefit from being in regular – or sinus – rhythm and these cardiologists are more aggressive about using a rhythm control strategy.

There are 3 basic aspects of a rhythm control strategy.

Cardioversion. This is using an electrical shock, medications or both to convert the rhythm from afib to sinus rhythm.  Initial success rates have been reported to be anywhere from 65 to 90% with about ½ still being in sinus rhythm at one year.

Medications . Common medications used to try to maintain sinus rhythm include:

  • Amiodarone
  • Flecainide
  • Propafenone
  • Sotalol
  • Dofetilide
  • Dronedarone

Medications are about 50% effective at 1 year in maintaining sinus rhythm. All medications have potential side effects which you should discuss with your doctor.

Ablation procedures. Afib ablation has revolutionized the treatment of afib.  The ablation procedure is more effective than medications, with about 70-75% of people still in sinus rhythm after 1 year with a single ablation procedure and up to 90% with multiple ablation procedures.

Ablation procedures do have risks which you should discuss with your physician.

The decision between whether to pursue a rate control strategy and accept afib or a rhythm control strategy of ablation, medication and cardioversion is a complex one and requires a detailed discussion between the patient and their physician to understand the pros and cons of each approach.  

Some of the accepted reasons to pursue a rhythm control strategy include

  • New onset afib
  • Afib from a reversible cause
  • When patients are symptomatic with afib, even with the heart rate controlled.
  • If heart failure is present and it’s thought that the afib contributed 
  • If the physician and the patient prefer a rhythm control strategy

Talk to your physician to determine what is the right strategy for you. 

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