A perspective on antiarrhythmic drug therapy to treat atrial fibrillation: there remains an unmet need.

Because presently available antiarrhythmic drugs are neither as highly efficacious nor as safe as desirable for the prevention of atrial fibrillation (AF), rate control-versus-rhythm control trials for the treatment of AF were evaluated. They demonstrated that rate control is not simply a therapeutic fallback option if rhythm control should fail, but rather, it is a legitimate primary therapeutic option. Nevertheless, there remain many reasons to consider maintenance of sinus rhythm (rhythm control) over AF (rate control) if only there were antiarrhythmic agents that could provide this treatment more effectively and safely. In fact, an important analysis of the AFFIRM trial data indicated that rhythm control offers a significant survival advantage over rate control if it could be safely achieved. Therein lie an important clinical dilemma and an unmet need. Sinus rhythm is good, but we need better ways to maintain it effectively and safely.