Restoring normal sinus rhythm in atrial fibrillation : evidence from pharmacologic therapy and catheter ablation trials.

Although clinical evidence indicates that many of the electrophysiologic and functional changes associated with atrial fibrillation (AF) can be reversed by maintaining normal sinus rhythm (NSR), a series of large-scale randomized trials failed to demonstrate that this strategy provides a survival advantage. These studies have methodologic limitations, however, that restrict their applicability to the entire AF population. Invasive techniques, including percutaneous catheter ablation and the surgical Maze procedure, offer the potential to reduce the frequency of and in some cases cure AF, although there are serious associated risks. The development and refinement of these techniques have improved outcomes, and they now represent a viable early option for select AF patients. In light of its manifest benefits, the restoration and maintenance of NSR through pharmacologic or nonpharmacologic treatment should remain the therapeutic objective for many AF patients.