Rate vs. Rhythm Control in AF

This Harvard Medical School Continuing Education video examines these key questions: How do you choose rate vs rhythm control for your patients with atrial fibrillation (AF)? What medications and nonpharmacologic methods are used to achieve rate and rhythm control? Are there benefits to early intervention for AF patients?
 
Dr. William Hucker, MD, a cardiologist at Massachusetts General Hospital, highlights the rising rates of atrial fibrillation in various patient populations and identifies treatment options, focusing on medications, nonpharmacologic therapies and lifestyle changes for achieving rate and rhythm control. The historical significance of the AFFIRM trial is discussed in relation to new studies revealing the benefits of early intervention for treating atrial fibrillation.

This video was peer reviewed by Dr. Jonathan Salik, TMD, MHPEd, Instructor of Medicine, Massachusetts General Hospital; and Dr. Sugantha Sundar, MD, Assistant Professor of Anesthesia, Beth Israel Deaconess Medical Center, to validate the quality and accuracy of the content.

00:00 | Introduction
00:38 | Prevalence of atrial fibrillation
01:39 | Reasons for pursuing rate control vs rhythm control
02:44 | Rate and rhythm control strategies
05:00 | The AFFIRM trial vs EAST-AFNET 4
08:50 | Adjunctive therapies for rhythm control
 
References:
Piccini JP, Hammill BG, Sinner MF, et al. Incidence and prevalence of atrial fibrillation and associated mortality among Medicare beneficiaries, 1993-2007. Circ Cardiovasc Qual Outcomes. 2012;5(1):85-93. doi:10.1161/CIRCOUTCOMES.111.962688 
  
Gillis AM, Verma A, Talajic M, Nattel S, Dorian P; CCS Atrial Fibrillation Guidelines Committee. Canadian Cardiovascular Society atrial fibrillation guidelines 2010: rate and rhythm management [published correction appears in Can J Cardiol. 2011 May-Jun;27(3):388]. Can J Cardiol. 2011;27(1):47-59. doi:10.1016/j.cjca.2010.11.001  
  
Wyse DG, Waldo AL, DiMarco JP, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002;347(23):1825-1833. doi:10.1056/NEJMoa021328 
  
Singh BN, Singh SN, Reda DJ, et al. Amiodarone versus sotalol for atrial fibrillation. N Engl J Med. 2005;352(18):1861-1872. doi:10.1056/NEJMoa041705 
  
Kirchhof P, Camm AJ, Goette A, et al. Early Rhythm-Control Therapy in Patients with Atrial Fibrillation. N Engl J Med. 2020;383(14):1305-1316. doi:10.1056/NEJMoa2019422 
  
Pathak RK, Elliott A, Middeldorp ME et al. Impact of CARDIOrespiratory FITness on Arrhythmia Recurrence in Obese Individuals With Atrial Fibrillation: The CARDIO-FIT Study, J Am Coll Cardiol. 2015. PMID: 26113406 
  
Singh BN, Singh SN, Reda DJ, et al. Amiodarone versus sotalol for atrial fibrillation. N Engl J Med. 2005;352(18):1861-1872. doi:10.1056/NEJMoa041705 
 
Notice: At this time, the content in this video is not accredited.