0
Reviews |

Rate- and Rhythm-Control Therapies in Patients With Atrial Fibrillation: A Systematic ReviewRate- and Rhythm-Control Therapies FREE

Sana M. Al-Khatib, MD, MHS; Nancy M. Allen LaPointe, PharmD; Ranee Chatterjee, MD, MPH; Matthew J. Crowley, MD; Matthew E. Dupre, PhD; David F. Kong, MD; Renato D. Lopes, MD, PhD; Thomas J. Povsic, MD, PhD; Shveta S. Raju, MD; Bimal Shah, MD; Andrzej S. Kosinski, PhD; Amanda J. McBroom, PhD; and Gillian D. Sanders, PhD
[+] Article and Author Information

From Duke Clinical Research Institute and Duke Evidence-based Practice Center, Duke University School of Medicine, and the Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina.

Disclaimer: The authors of this article are responsible for its contents. Statements in the article should not be construed as endorsements by AHRQ or the U.S. Department of Health and Human Services.

Grant Support: By AHRQ (contract 290-2007-10066-I).

Disclosures: Dr. Allen LaPointe reports grants from AHRQ during the conduct of the study and grants from Pfizer outside the submitted work. Dr. Kong reports grants from AHRQ during the conduct of the study. Dr. Lopes reports personal fees from Bayer, Boehringer Ingelheim, and Pfizer; grants and personal fees from Bristol-Myers Squibb; and grants from GlaxoSmithKline outside the submitted work. Dr. Shah reports personal fees from Bristol-Myers Squibb, Cardinal, Castlight, and Janssen Pharmaceutical and grants from Amgen, Amylin/BMS, and Lilly outside the submitted work. Dr. McBroom reports other funding from AHRQ during the conduct of the study. Dr. Sanders reports grants from AHRQ during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-1467.

Requests for Single Reprints: Sana M. Al-Khatib, MD, MHS, Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715; e-mail, alkha001@mc.duke.edu.

Current Author Addresses: Drs. Al-Khatib, Allen LaPointe, Dupre, Kong, Lopes, Shah, Kosinski, McBroom, and Sanders: Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715.

Dr. Chatterjee: Sutton Station Internal Medicine, 5832 Fayetteville Road, Suite 113, Durham, NC 27713.

Dr. Crowley: Durham Veterans Affairs Medical Center, Health Services Research & Development (152), 508 Fulton Street, Durham, NC 27705.

Dr. Povsic: Duke University Medical Center, Bell Building, Room 348, Durham, NC 27710.

Dr. Raju: Gwinnett Clinic, 475 Philip Boulevard, Suite 100, Lawrenceville, GA 30046.

Author Contributions: Conception and design: S.M. Al-Khatib, N.M. Allen LaPointe, D.F. Kong, R.D. Lopes, S.S. Raju, B. Shah, A.J. McBroom, G.D. Sanders.

Analysis and interpretation of the data: S.M. Al-Khatib, N.M. Allen LaPointe, R. Chatterjee, M.J. Crowley, D.F. Kong, R.D. Lopes, T.J. Povsic, S.S. Raju, B. Shah, A.S. Kosinski, A.J. McBroom, G.D. Sanders.

Drafting of the article: S.M. Al-Khatib, N.M. Allen LaPointe, R. Chatterjee, M.J. Crowley, A.J. McBroom, G.D. Sanders.

Critical revision of the article for important intellectual content: N.M. Allen LaPointe, R. Chatterjee, M.J. Crowley, D.F. Kong, R.D. Lopes, T.J. Povsic, B. Shah, A.J. McBroom, G.D. Sanders.

Final approval of the article: N.M. Allen LaPointe, M.J. Crowley, R.D. Lopes, T.J. Povsic, B. Shah, G.D. Sanders.

Statistical expertise: D.F. Kong, A.S. Kosinski, G.D. Sanders.

Obtaining of funding: G.D. Sanders.

Administrative, technical, or logistic support: M.E. Dupre, A.J. McBroom, G.D. Sanders.

Collection and assembly of data: S.M. Al-Khatib, N.M. Allen LaPointe, R. Chatterjee, M.J. Crowley, M.E. Dupre, R.D. Lopes, B. Shah, A.J. McBroom, G.D. Sanders.


Ann Intern Med. 2014;160(11):760-773. doi:10.7326/M13-1467
Text Size: A A A

Background: The comparative effectiveness of treatments for atrial fibrillation (AF) is uncertain.

Purpose: To evaluate the comparative effectiveness of rate- and rhythm-control therapies.

Data Sources: English-language studies in PubMed, EMBASE, and the Cochrane Database of Systematic Reviews between January 2000 and November 2013.

Study Selection: Two reviewers independently screened citations to identify comparative studies that assessed rate- or rhythm-control therapies in patients with AF.

Data Extraction: Reviewers extracted data on study design, participant characteristics, interventions, outcomes, applicability, and quality.

Data Synthesis: 200 articles (162 studies) involving 28 836 patients were included. When pharmacologic rate- and rhythm-control strategies were compared, strength of evidence (SOE) was moderate supporting comparable efficacy with regard to all-cause mortality (odds ratio [OR], 1.34 [95% CI, 0.89 to 2.02]), cardiac mortality (OR, 0.96 [CI, 0.77 to 1.20]), and stroke (OR, 0.99 [CI, 0.76 to 1.30]) in older patients with mild AF symptoms. Few studies compared rate-control therapies and included outcomes of interest, which limited conclusions. For the effect of rhythm-control therapies in reducing AF recurrence, SOE was high favoring pulmonary vein isolation versus antiarrhythmic medications (OR, 5.87 [CI, 3.18 to 10.85]) and the surgical maze procedure (including pulmonary vein isolation) done during other cardiac surgery versus other cardiac surgery alone (OR, 7.94 [CI, 3.63 to 17.36]).

Limitation: Studies were heterogeneous in interventions, populations, settings, and outcomes.

Conclusion: Pharmacologic rate- and rhythm-control strategies have comparable efficacy across outcomes in primarily older patients with mild AF symptoms. Pulmonary vein isolation is better than antiarrhythmic medications at reducing recurrences of AF in younger patients with paroxysmal AF and mild structural heart disease. Future research should address uncertainties related to subgroups of interest and the effect of different therapies on long-term clinical outcomes.

Primary Funding Source: Agency for Healthcare Research and Quality.


Atrial fibrillation (AF) is a major public health problem in the United States. More than 2.3 million Americans are estimated to have AF (1). The known association between AF and substantial mortality, morbidity, and health care costs compounds the effect of this condition. Not only is the risk for death in patients with AF twice that of patients without it, but AF can result in myocardial ischemia and infarction, exacerbate heart failure (HF), and cause tachycardia-induced cardiomyopathy if the ventricular rate is not well-controlled (25).

The most dreaded complication of AF is thromboembolism, especially stroke (6). In some patients, AF or therapies to manage this condition can severely depreciate quality of life (710). Furthermore, the management of AF and its complications is responsible for nearly $16 billion in additional costs to the U.S. health care system per year (11).

Despite the substantial public health effect of AF, uncertainties around its management remain. In particular, the comparative safety and effectiveness of different rate- and rhythm-control therapies for patients with AF are unclear. We conducted this systematic review to evaluate the comparative safety and effectiveness of rate- versus rhythm-control strategies; medications used for ventricular rate control; strict versus more lenient rate-control strategies; nonpharmacologic rate-control therapies versus medications; electrical cardioversion and antiarrhythmic medications for restoration of sinus rhythm; and catheter ablation, surgical ablation, and antiarrhythmic medications for maintenance of sinus rhythm.

We developed and followed a standard protocol for our review. Full details of our methods, search strategies, results, and conclusions are presented in a comparative effectiveness review commissioned by the Agency for Healthcare Research and Quality (AHRQ) and are available at www.effectivehealthcare.ahrq.gov(12).

Data Sources and Searches

We searched PubMed, EMBASE, and the Cochrane Database of Systematic Reviews for studies published between 1 January 2000 and 12 November 2013. Data before 2000 have been summarized in an AHRQ report on the management of new-onset AF published in 2001 (1315).

Study Selection

We identified randomized, controlled trials (RCTs) published in English that were comparative assessments of pharmacologic or nonpharmacologic rate- or rhythm-control therapies aimed at treating adults with AF. Observational studies were also allowed for comparisons of strict versus lenient rate control or cardiac resynchronization therapy versus other rhythm-control therapies. The following outcomes were considered: restoration of sinus rhythm (conversion), maintenance of sinus rhythm, recurrence of AF at 12 months, development of cardiomyopathy, death (all-cause and cardiac), myocardial infarction, cardiovascular hospitalizations, HF symptoms, control of AF symptoms, quality of life, functional status, stroke and other embolic events, bleeding events, and adverse effects of therapy.

Data Extraction and Quality Assessment

One investigator abstracted and another confirmed data related to study setting and design, patient characteristics, details of treatment, comparators, and relevant outcomes. The quality of individual studies was evaluated using the approach described in AHRQ's Methods Guide for Effectiveness and Comparative Effectiveness Reviews(16). Investigators also assessed factors that limited applicability of the evidence.

Data Synthesis and Analysis

For each treatment comparison and outcome of interest, we determined the feasibility of completing a quantitative synthesis (meta-analysis) based on the volume of relevant literature, conceptual homogeneity of the studies (both in terms of study population and outcomes), and completeness of the reporting of results. We considered meta-analysis for outcomes that at least 3 studies reported.

For our evaluation of rate- versus rhythm-control strategies, we grouped all rate-control strategies together and all rhythm-control strategies together, regardless of the specific medication or procedure. We grouped pharmacologic interventions by class, considering rate-controlling calcium-channel blockers and all β-blockers each to be similar enough to be grouped together. We categorized procedures into electrical cardioversion, atrioventricular node (AVN) ablation, AF ablation by pulmonary vein isolation (PVI) (by open surgical, minimally invasive, or transcatheter procedures), and different types of surgical maze procedures and explored comparisons among these categories. In addition, for the comparisons focusing on medications versus procedures, we also explored grouping all medications together and comparing them with all procedures.

When a meta-analysis was appropriate, we used a random-effects model to synthesize the available evidence quantitatively using Comprehensive Meta-Analysis, version 2 (Biostat, Englewood, New Jersey). We used a standardized approach to rank the overall strength of evidence (SOE) for each outcome (16).

Role of the Funding Source

Primary funding was provided by AHRQ. Neither the technical experts nor AHRQ representatives had a role in the literature search, data analysis, interpretation of the data, or decision to submit the manuscript for publication.

We screened 10 495 abstracts, evaluated 570 full-text articles, and included 200 articles representing 162 studies involving 28 836 patients (Figure 1). Tables 1 to 6 of the Supplement provide details about these studies and their populations for each topic described here. Table 7 of the Supplement lists identified and potential limitations of the studies. The full AHRQ report highlights additional findings (12).

Grahic Jump Location
Figure 1.

Summary of evidence search and selection.

AAD = antiarrhythmic drug; CRT = cardiac resynchronization therapy; RCT = randomized, controlled trial.

* Some studies were relevant to more than 1 topic.

Grahic Jump Location
Rate- Versus Rhythm-Control Strategies

We included 16 RCTs in this analysis: 13 compared pharmacologic rhythm-control versus rate-control strategies (1729) and 3 compared a rhythm-control strategy with PVI versus a rate-control strategy that involved AVN ablation and implantation of a pacemaker in 1 study (30) and rate-controlling medications in the other 2 (3132).

Ten RCTs (1718, 2022, 2428) provided information on outcomes of interest and were combined quantitatively (Figure 2). Of these, 5 included only patients with persistent AF (2022, 25, 28), 1 included only patients with paroxysmal AF (17), and 4 included patients with paroxysmal or persistent AF (18, 24, 2627). Two studies (17, 22) compared a single-chamber pacemaker plus AVN ablation versus a dual-chamber pacemaker plus AVN ablation plus an antiarrhythmic medication; all others compared largely unspecified rate-control with rhythm-control strategies.

Grahic Jump Location
Figure 2.

Meta-analysis forest plots.

AAD = antiarrhythmic drug; PVI = pulmonary vein isolation. A. All-cause mortality for rate- vs. rhythm-control strategies. B. Cardiovascular mortality for rate- vs. rhythm-control strategies. C. Stroke for rate- vs. rhythm-control strategies. D. Restoration of sinus rhythm for monophasic vs. biphasic waveforms. E. Maintenance of sinus rhythm for PVI vs. AAD therapy.

Grahic Jump Location

Data from the included studies showed moderate SOE that pharmacologic rate- and rhythm-control strategies are of comparable efficacy with regard to their effect on all-cause mortality (odds ratio [OR], 1.34 [95% CI, 0.89 to 2.02]; Q = 21.71; P = 0.003) (Figure 2, A) (18, 2022, 24, 2628), cardiac mortality (OR, 0.96 [CI, 0.77 to 1.20]; Q = 3.55; P = 0.47) (Figure 2, B) (18, 2122, 2425), and stroke (OR, 0.99 [CI, 0.76 to 1.30]; Q = 7.02; P = 0.43) (Figure 2, C) (1718, 2022, 24, 2728). Although the meta-analysis for all-cause mortality showed a potential benefit, it did not reach statistical significance and 6 of the 8 studies (6069 patients [95%]) had ORs that crossed 1, resulting in a final moderate SOE. For cardiac mortality (Figure 2, B), point estimates were inconsistent and CIs were wide for 2 of the 5 studies (18, 21), but there was no evidence of heterogeneity; therefore, our SOE rating was not affected. For the outcome of stroke, there was no evidence of heterogeneity, but the findings were mostly driven by 1 large, good-quality RCT (4060 patients), which was inconsistent with several of the smaller studies, reducing our confidence in the finding and in the SOE. These studies largely included older patients with mild AF symptoms.

Three RCTs compared pharmacologic rate-control strategies with rhythm-control strategies using antiarrhythmic medications (1718, 22). These RCTs showed fewer cardiovascular hospitalizations with the rhythm-control strategies (1718, 22). Although data from 5 RCTs suggest that there is no difference between pharmacologic rate- and rhythm-control strategies in their effect on HF symptoms (17, 22, 24, 26, 46) (Table 1), a prespecified substudy of the Atrial Fibrillation and Congestive Heart Failure study showed that a higher proportion of time spent in sinus rhythm was associated with a greater improvement in New York Heart Association class (29).

Table Jump PlaceholderTable 1. Summary of SOE and Effect Estimates for Rate- Versus Rhythm-Control Strategies 

Three studies compared a rhythm-control strategy involving catheter ablation with a rate-control strategy involving rate-controlling medications (32) or AVN ablation combined with implantation of a pacemaker (30) or rate-controlling medications (31). One study showed that catheter ablation was better than pharmacologic rate control at improving symptoms, neurohormonal status, and objective physiologic exercise capacity (32). Another study showed that PVI isolation was superior to AVN ablation and pacemaker implantation in improving quality of life, 6-minute walk distance, and ejection fraction (30). Another study showed that PVI resulted in long-term restoration of sinus rhythm in only 50% of patients (compared with none in the medical treatment group) and did not improve ejection fraction compared with a rate-control strategy (31).

Medications for Ventricular Rate Control

Sixteen RCTs (4762) assessed the use of medications for ventricular rate control. Of these, 3 included only patients with permanent AF (59, 6162), 1 included only patients with paroxysmal AF (52), and 4 included only patients with persistent AF (50, 5354, 56). Most studies compared 2 or more of the following medications: a β-blocker, a calcium-channel blocker, digoxin, or amiodarone.

Although we found evidence that reduction of ventricular response during AF in symptomatic patients benefits patients by reducing the risk for tachycardia-induced cardiomyopathy, HF, and MI and by improving quality of life, data were inconclusive as to whether any 1 medication used for ventricular rate control is safer or more effective than the others (Table 2).

Table Jump PlaceholderTable 2. Summary of SOE and Effect Estimates for Medications Used for Ventricular Rate Control 
Strict Versus More Lenient Rate-Control Strategies

Few studies have evaluated the comparative safety and effectiveness of a strict versus more lenient rate-control strategy; these included 1 good-quality RCT (63) in patients with permanent AF and 2 observational studies (6465) that were secondary analyses of RCTs. There were no statistically significant differences in all-cause and cardiovascular mortality, HF symptoms, cardiovascular hospitalizations, bleeding events, quality of life, and control of AF symptoms between strict and lenient rate-control strategies, and evidence was limited by the small number of studies and the imprecision of their findings.

Nonpharmacologic Rate-Control Therapies Versus Medications

Six RCTs (22, 6670) evaluated the comparative effectiveness of a procedural intervention versus a primarily pharmacologic intervention for rate control of AF (22, 6667, 70) or of 2 procedural interventions, with pharmacologic therapy used in only 1 group (6869).

The studies varied in the types of procedures and pharmacologic interventions evaluated. All studies included at least 1 treatment group with radiofrequency ablation or modification of the AVN or His bundle, most often in conjunction with pacemaker placement. The comparison groups included a pharmacologic intervention whose main purpose was to control ventricular heart rate and a procedure that involved a pacemaker implant and AVN ablation in some studies.

Four studies reported outcomes related to heart rate control at approximately 1 year. In the 3 studies that compared a procedural intervention with a pharmacologic intervention, the patients in the procedural intervention group had a lower heart rate at 12 months than those receiving the pharmacologic intervention (6667, 70). Three studies compared outcomes related to exercise capacity or duration, and none showed significant differences in these outcomes by treatment group of ventricular demand rate-responsive (VVIR) pacing plus His bundle ablation versus VVIR pacing plus a rate-controlling medication or of AVN ablation plus VVIR pacing versus a rate-controlling medication (6667, 69).

Three studies reported outcomes related to mortality and cardiovascular events. No significant differences were found by treatment group in a comparison of AVN ablation plus dual-chamber demand rate-responsive pacing and antiarrhythmic therapy versus AVN ablation plus VVIR pacing alone or in a comparison of AVN ablation plus VVIR pacing versus a rate-controlling medication (22, 67, 69).

Electrical Cardioversion and Antiarrhythmic Medications for Restoration of Sinus Rhythm

Forty-four RCTs (3336, 49, 5354, 56, 58, 71105) assessed the use of antiarrhythmic medications or electrical cardioversion for restoration of sinus rhythm. Four RCTs compared single monophasic waveform with single biphasic waveform for converting AF to sinus rhythm (3336). All studies were done in patients with persistent AF. Pooling data from these 4 RCTs showed the superiority of a single biphasic waveform over a single monophasic waveform (OR, 4.39 [CI, 2.84 to 6.78]; Q = 2.85; P = 0.42) (Figure 2, D).

Four studies explored the use of anterolateral versus anteroposterior positioning of cardioversion electrodes in patients with persistent AF (75, 82, 86, 99). There was low SOE of no difference in restoration of sinus rhythm.

Few identified studies directly compared similar antiarrhythmic medications. The most frequent comparison was between amiodarone and sotalol, which was evaluated in 4 studies (58, 7980, 89) involving patients with paroxysmal or persistent AF. Meta-analysis of these studies showed no statistically significant difference in restoring sinus rhythm (OR, 1.12 [CI, 0.81 to 1.56]) (Table 3).

Table Jump PlaceholderTable 3. Summary of SOE and Effect Estimates for Electrical Cardioversion and Antiarrhythmic Medications for Rhythm Control 
Catheter Ablation, Surgical Ablation, and Antiarrhythmic Medications for Maintenance of Sinus Rhythm

Ninety studies assessed the comparative safety and effectiveness of new procedural rhythm-control therapies, other nonpharmacologic rhythm-control therapies, and pharmacologic agents for the maintenance of sinus rhythm in patients with AF. We divided these studies into 2 groups by therapy type: procedural and pharmacologic.

Seventy-two RCTs (3746, 106167) addressed procedures for rhythm control. Nine RCTs compared transcatheter PVI with antiarrhythmic medications. Of these, 2 included only patients with paroxysmal AF (40, 42), 2 included only patients with persistent AF (39, 45), and 5 included patients with paroxysmal or persistent AF (3738, 41, 4344). Data from these trials provide high SOE that rhythm control using transcatheter PVI is superior to antiarrhythmic medications in reducing recurrent AF over 12 months of follow-up (OR, 5.87 [CI, 3.18 to 10.85]; Q = 33.82; P < 0.001) (Figure 2, E). This SOE is strongest in younger patients with little to no structural heart disease and with no or mild enlargement of the left atrium (3745).

The Appendix Table presents data on surgical maze procedures (including PVI) at the time of other cardiac surgery. Ten studies evaluated PVI with valvular or coronary artery bypass graft versus valvular surgery or coronary artery bypass graft alone (46, 107, 111, 113, 118, 124, 136137, 149, 168). Five studies evaluated traditional “cut-and-sew” maze procedures versus valvular surgery or coronary artery bypass graft alone (127, 138, 142, 146, 154). Four additional studies evaluated unique comparisons (108, 133, 155, 158). Data from 8 RCTs showed high SOE that PVI at the time of other cardiac surgery is superior to cardiac surgery alone in reducing AF recurrence over at least 12 months of follow-up in patients with persistent (111, 136137, 149) or long-standing persistent (46, 107, 113, 118) AF.

Table Jump PlaceholderAppendix Table. Summary of SOE and Effect Estimates for Procedural Rhythm-Control Therapies 

Of the 9 RCTs that compared PVI plus complex fractionated atrial electrographic (CFAE) ablation versus PVI alone, 1 included only patients with long-standing persistent AF (119), 2 included only patients with persistent AF (115, 160), and 4 included only patients with paroxysmal AF (112, 114, 140, 153). On the basis of the results of these heterogeneous RCTs, there is low SOE that CFAE ablation done in addition to PVI does not increase maintenance of sinus rhythm at 12 months compared with PVI only.

Regarding procedures for maintenance of sinus rhythm, 4 areas were found to need more data: the effect of transcatheter PVI on final outcomes, such as all-cause mortality, stroke, HF, and ejection fraction; the efficacy and effectiveness of transcatheter PVI by type and duration of AF, presence or absence of structural heart disease, and size of the left atrium; the best ablation approach; and the effect of the surgical maze procedure and PVI done at the time of surgery on final outcomes, such as all-cause mortality and stroke, and on the safety and durability of the effectiveness of these procedures beyond 12 months (Appendix Table).

Eighteen studies (5354, 7880, 104, 169180) evaluated the comparative safety or effectiveness of pharmacologic agents with or without external electrical cardioversion for maintaining sinus rhythm in patients with AF. Five studies evaluated the use of 1 or more pharmacologic agent, with external electrical cardioversion as a primary component of the tested intervention (5354, 78, 104, 180); 1 compared an antiarrhythmic medication with a rate-controlling medication (sotalol vs. bisoprolol) (179); 1 primarily evaluated the effect of the addition of verapamil to either amiodarone or flecainide (174); 1 compared the effect of 2 β-blockers for maintenance of sinus rhythm after cardioversion (169); and 10 compared 2 or more antiarrhythmic medications (7980, 170173, 175178).

Amiodarone, sotalol, and propafenone were the most commonly studied antiarrhythmic medications in RCTs assessing the pharmacologic maintenance of sinus rhythm (7980, 169179). Only 1 study, a substudy of the Atrial Fibrillation Follow-up Investigation of Rhythm Management study, systematically assessed differences in mortality rates between antiarrhythmic medications and found no statistically significant difference between patients receiving amiodarone versus those receiving sotalol (172). Regarding maintaining sinus rhythm and reducing recurrence of AF, amiodarone was better than sotalol and dronedarone but did not differ from propafenone in the few studies that compared the various medications (low SOE).

This review of 162 studies involving 28 836 patients has 4 main findings. First, in older patients with mild AF symptoms, a pharmacologic rate-control strategy has comparable efficacy to a pharmacologic rhythm-control strategy in terms of its effect on all-cause mortality, cardiac mortality, and stroke. Second, we found few studies comparing different rate-controlling medications and reporting on outcomes of interest. The number of clinical trials comparing different antiarrhythmic medications was also small. Third, PVI is superior to antiarrhythmic medications at reducing AF recurrence in younger patients with no substantial structural heart disease. Fourth, the surgical maze procedure done at the time of other cardiac surgery is superior to cardiac surgery alone at reducing AF recurrence. Although our review of all available data in the literature left several unanswered questions, we provide important information on the rigor of evidence that supports or does not support certain interventions and practices.

We found evidence supporting the comparable effectiveness of pharmacologic rate- and rhythm-control strategies in their effect on all-cause mortality, cardiac mortality, and stroke. As the largest analysis to date addressing this issue to our knowledge, our review provides further confirmation that pharmacologic rate-control strategies are of comparable efficacy to pharmacologic rhythm-control strategies in patients similar to those enrolled in the RCTs (namely, older patients with mild symptoms from AF). Follow-up in the included trials ranged from 4 months to 3.5 years. Although a comparative effectiveness study of population-based administrative databases from Québec, Canada, from 1999 to 2007 also found little difference in mortality rates within 4 years of treatment initiation, mortality rates decreased steadily in the rhythm-control group after 5 years (181).

Our review found a lack of definitive evidence for better rate control with β-blockers compared with verapamil or diltiazem. Amiodarone and diltiazem are similar options for rate control, and the available evidence suggests that amiodarone or verapamil is a better option for rate control than digoxin (47, 53). For patients presenting to the emergency department with AF, metoprolol or diltiazem produces similar results for rate control. However, there is a general lack of information on comparative safety of the agents overall and within specific patient subgroups. Our findings underscore the importance of conducting studies comparing the effectiveness, tolerability, and safety of different β-blockers and in different patient populations.

Although few studies have suggested that lenient rate control may be as good as strict rate control, this finding needs to be confirmed.

Studies that explored the effect of AVN ablation and pacemaker implantation versus AVN blockers on ventricular rate control showed a significantly lower heart rate in patients who had a procedure. Studies of other outcomes found no difference by treatment group or were inconsistent. There is a need for well-designed studies comparing final outcomes in patients receiving rate-controlling medications versus those having rate-controlling procedures.

We found that biphasic waveform cardioversion was superior to monophasic waveform cardioversion. Showing no significant difference in restoration of sinus rhythm with use of anterolateral versus anteroposterior positioning of cardioversion electrodes is important and clinically helpful because health care providers often debate the superiority of 1 positioning of cardioversion electrodes over another. Although data suggest that pretreatment enhances electrical cardioversion in terms of restoration and maintenance of sinus rhythm, our review does not support 1 antiarrhythmic medication as superior to others in such pretreatment. These findings call for studies comparing the effectiveness and safety of medication pretreatments in enhancing restoration of sinus rhythm.

Although additional data are needed on final outcomes, evidence is strong in support of the use of PVI versus antiarrhythmic medications for reducing recurrences of AF in younger patients with paroxysmal AF who have mild structural heart disease or mild left atrial enlargement. These studies mostly examined PVI as second-line therapy. One recent study compared PVI with antiarrhythmic medications as first-line therapy in patients with paroxysmal AF. It found no significant difference in the burden of AF over 2 years (182). More studies are needed on PVI as first-line therapy.

The effect of PVI on final outcomes, including mortality, is being assessed by the ongoing National Heart, Lung, and Blood Institute–funded Catheter Ablation Versus Antiarrhythmic Drug Therapy for AF trial. Less evidence supports the use of PVI versus antiarrhythmic medications in similar types of patients with persistent AF. Unlike previous studies, we found that CFAE ablation in addition to PVI did not increase maintenance of sinus rhythm compared with PVI only. Although it is unclear whether this finding is due to including more patients with persistent AF in our review, the influence of AF type and duration on the effectiveness of CFAE ablation should be considered. Our findings underscore the importance of conducting well-powered and well-designed RCTs to address this issue definitively, especially as it relates to appropriate patient selection for CFAE ablation.

We found that the surgical maze procedure or PVI done at the time of cardiac surgery is superior to cardiac surgery only in reducing AF recurrence over 12 months of follow-up in patients with persistent or permanent AF. However, data on final outcomes, such as all-cause mortality, are largely absent. Therefore, our findings support exploring these interventions further in regard to their effect on final outcomes and in different patient populations.

In RCTs that examined the comparative effectiveness of different antiarrhythmic medications in maintaining sinus rhythm, we found that amiodarone, sotalol, and propafenone were the most frequently studied agents. Amiodarone did not differ from propafenone in the few studies that compared these medications. Our findings highlight the importance of future research to compare different antiarrhythmic medications in specific patient populations.

Our review has limitations. By using narrow eligibility criteria, the included studies may not be representative of the full clinical spectrum of patients and settings. Although understanding racial and sex differences in the effectiveness of rhythm control versus rate control is of interest, these data do not exist. Trials of procedures typically use highly selected operators and may not apply to less experienced operators. Our review was limited to English-language publications. In this analysis, we had to rely on the description of the papers' authors about the techniques that they used and the extent of ablation. Because of the heterogeneity and inherent difficulties in monitoring patients for recurrence of AF, findings related to this outcome should be interpreted with this limitation in mind.

As the largest analysis examining pharmacologic rate versus rhythm control to our knowledge, our review provides confirmation that pharmacologic rate- and rhythm-control strategies are of comparable efficacy in older patients with mild symptoms from AF. Although more data are needed on final outcomes, robust evidence supports the use of PVI versus antiarrhythmic medications for reducing recurrences of AF in younger patients with paroxysmal AF and mild structural heart disease. Uncertainties still exist within specific subgroups of interest, among therapies within each strategic approach, and about the effect of strategies on long-term clinical outcomes. Our review highlights areas for future research needed for clinical decision making in the treatment of AF.

Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001; 285:2370-5.
PubMed
CrossRef
 
Krahn AD, Manfreda J, Tate RB, Mathewson FA, Cuddy TE. The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study. Am J Med. 1995; 98:476-84.
PubMed
CrossRef
 
Poole-Wilson PA, Swedberg K, Cleland JG, Di Lenarda A, Hanrath P, Komajda M, et al, Carvedilol Or Metoprolol European Trial Investigators. Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial. Lancet. 2003; 362:7-13.
PubMed
CrossRef
 
Maggioni AP, Latini R, Carson PE, Singh SN, Barlera S, Glazer R, et al, Val-HeFT Investigators. Valsartan reduces the incidence of atrial fibrillation in patients with heart failure: results from the Valsartan Heart Failure Trial (Val-HeFT). Am Heart J. 2005; 149:548-57.
PubMed
CrossRef
 
Wang TJ, Larson MG, Levy D, Vasan RS, Leip EP, Wolf PA, et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation. 2003; 107:2920-5.
PubMed
CrossRef
 
Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991; 22:983-8.
PubMed
CrossRef
 
Singh SN, Tang XC, Singh BN, Dorian P, Reda DJ, Harris CL, et al, SAFE-T Investigators. Quality of life and exercise performance in patients in sinus rhythm versus persistent atrial fibrillation: a Veterans Affairs Cooperative Studies Program Substudy. J Am Coll Cardiol. 2006; 48:721-30.
PubMed
CrossRef
 
Dorian P, Jung W, Newman D, Paquette M, Wood K, Ayers GM, et al. The impairment of health-related quality of life in patients with intermittent atrial fibrillation: implications for the assessment of investigational therapy. J Am Coll Cardiol. 2000; 36:1303-9.
PubMed
CrossRef
 
Chung MK, Shemanski L, Sherman DG, Greene HL, Hogan DB, Kellen JC, et al, AFFIRM Investigators. Functional status in rate- versus rhythm-control strategies for atrial fibrillation: results of the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Functional Status Substudy. J Am Coll Cardiol. 2005; 46:1891-9.
PubMed
CrossRef
 
Hagens VE, Ranchor AV, Van Sonderen E, Bosker HA, Kamp O, Tijssen JG, et al, RACE Study Group. Effect of rate or rhythm control on quality of life in persistent atrial fibrillation. Results from the Rate Control Versus Electrical Cardioversion (RACE) Study. J Am Coll Cardiol. 2004; 43:241-7.
PubMed
CrossRef
 
Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al, American College of Cardiology. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 guidelines for the management of patients with atrial fibrillation) developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Europace. 2006; 8:651-745.
PubMed
CrossRef
 
Al-Khatib SM, Allen Lapointe N, Chatterjee R, Crowley MJ, Dupre ME, Kong DF, et al.  Treatment of Atrial Fibrillation. Comparative Effectiveness Review No. 119. (Prepared by the Duke Evidence-based Practice Center under contract no. 290-2007-10066-I.) AHRQ Publication No. 13-EHC095-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2013. Accessed at www.effectivehealthcare.ahrq.gov/ehc/products/358/1559/atrial-fibrillation-report-130628.pdf on 14 April 2014.
 
McNamara RL, Bass EB, Miller MR, Segal JB, Goodman SN, Kim NL, et al.  Management of New Onset Atrial Fibrillation. Evidence Report/Technology Assessment No. 12. (Prepared by the Johns Hopkins University Evidence-based Practice Center under contract no. 290-97-0006.) AHRQ Publication No. 01-E026. Rockville, MD: Agency for Healthcare Research and Quality; 2001. Accessed at www.ncbi.nlm.nih.gov/books/NBK33108 on 30 October 2012.
 
McNamara RL, Bass EB, Miller MR, Segal JB, Goodman SN, Kim NL, et al. Management of new onset atrial fibrillation. Evid Rep Technol Assess (Summ). 2000; 1-7.
PubMed
 
McNamara RL, Tamariz LJ, Segal JB, Bass EB. Management of atrial fibrillation: review of the evidence for the role of pharmacologic therapy, electrical cardioversion, and echocardiography. Ann Intern Med. 2003; 139:1018-33.
PubMed
CrossRef
 
Agency for Healthcare Research and Quality.  Methods Guide for Effectiveness and Comparative Effectiveness Reviews. Rockville, MD: Agency for Healthcare Research and Quality; 2014. Accessed at www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=318 on 31 October 2011.
 
Brignole M, Menozzi C, Gasparini M, Bongiorni MG, Botto GL, Ometto R, et al, PAF 2 Study Investigators. An evaluation of the strategy of maintenance of sinus rhythm by antiarrhythmic drug therapy after ablation and pacing therapy in patients with paroxysmal atrial fibrillation. Eur Heart J. 2002; 23:892-900.
PubMed
CrossRef
 
Carlsson J, Miketic S, Windeler J, Cuneo A, Haun S, Micus S, et al, STAF Investigators. Randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation: the Strategies of Treatment of Atrial Fibrillation (STAF) study. J Am Coll Cardiol. 2003; 41:1690-6.
PubMed
CrossRef
 
Hohnloser SH, Kuck KH, Lilienthal J. Rhythm or rate control in atrial fibrillation—Pharmacological Intervention in Atrial Fibrillation (PIAF): a randomised trial. Lancet. 2000; 356:1789-94.
PubMed
CrossRef
 
Okçün B, Yigit Z, Arat A, Küçükoglu SM. Comparison of rate and rhythm control in patients with atrial fibrillation and nonischemic heart failure. Jpn Heart J. 2004; 45:591-601.
PubMed
CrossRef
 
Opolski G, Torbicki A, Kosior DA, Szulc M, Wozakowska-Kaplon B, Kolodziej P, et al, Investigators of the Polish How to Treat Chronic Atrial Fibrillation Study. Rate control vs rhythm control in patients with nonvalvular persistent atrial fibrillation: the results of the Polish How to Treat Chronic Atrial Fibrillation (HOT CAFE) Study. Chest. 2004; 126:476-86.
PubMed
CrossRef
 
Petrac D, Radic B, Radeljic V, Hamel D, Filipovic J. Ventricular pacing vs dual chamber pacing in patients with persistent atrial fibrillation after atrioventricular node ablation: open randomized study. Croat Med J. 2005; 46:922-8.
PubMed
 
Shelton RJ, Clark AL, Goode K, Rigby AS, Houghton T, Kaye GC, et al. A randomised, controlled study of rate versus rhythm control in patients with chronic atrial fibrillation and heart failure: (CAFE-II Study). Heart. 2009; 95:924-30.
PubMed
CrossRef
 
Talajic M, Khairy P, Levesque S, Connolly SJ, Dorian P, Dubuc M, et al, AF-CHF Investigators. Maintenance of sinus rhythm and survival in patients with heart failure and atrial fibrillation. J Am Coll Cardiol. 2010; 55:1796-802.
PubMed
CrossRef
 
Van Gelder IC, Hagens VE, Bosker HA, Kingma JH, Kamp O, Kingma T, et al, Rate Control versus Electrical Cardioversion for Persistent Atrial Fibrillation Study Group. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med. 2002; 347:1834-40.
PubMed
CrossRef
 
Vora A, Karnad D, Goyal V, Naik A, Gupta A, Lokhandwala Y, et al. Control of heart rate versus rhythm in rheumatic atrial fibrillation: a randomized study. J Cardiovasc Pharmacol Ther. 2004; 9:65-73.
PubMed
CrossRef
 
Wyse DG, Waldo AL, DiMarco JP, Domanski MJ, Rosenberg Y, Schron EB, et al, Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002; 347:1825-33.
PubMed
CrossRef
 
Yildiz A, Yigit Z, Okcun B, Baskurt M, Ortak K, Kaya A, et al. Comparison of rate and rhythm control in hypertension patients with atrial fibrillation. Circ J. 2008; 72:705-8.
PubMed
CrossRef
 
Suman-Horduna I, Roy D, Frasure-Smith N, Talajic M, Lespérance F, Blondeau L, et al, AF-CHF Trial Investigators. Quality of life and functional capacity in patients with atrial fibrillation and congestive heart failure. J Am Coll Cardiol. 2013; 61:455-60.
PubMed
CrossRef
 
Khan MN, Jaïs P, Cummings J, Di Biase L, Sanders P, Martin DO, et al, PABA-CHF Investigators. Pulmonary-vein isolation for atrial fibrillation in patients with heart failure. N Engl J Med. 2008; 359:1778-85.
PubMed
CrossRef
 
MacDonald MR, Connelly DT, Hawkins NM, Steedman T, Payne J, Shaw M, et al. Radiofrequency ablation for persistent atrial fibrillation in patients with advanced heart failure and severe left ventricular systolic dysfunction: a randomised controlled trial. Heart. 2011; 97:740-7.
PubMed
CrossRef
 
Jones DG, Haldar SK, Hussain W, Sharma R, Francis DP, Rahman-Haley SL, et al. A randomized trial to assess catheter ablation versus rate control in the management of persistent atrial fibrillation in heart failure. J Am Coll Cardiol. 2013; 61:1894-903.
PubMed
CrossRef
 
Ricard P, Lévy S, Boccara G, Lakhal E, Bardy G. External cardioversion of atrial fibrillation: comparison of biphasic vs monophasic waveform shocks. Europace. 2001; 3:96-9.
PubMed
CrossRef
 
Page RL, Kerber RE, Russell JK, Trouton T, Waktare J, Gallik D, et al, BiCard Investigators. Biphasic versus monophasic shock waveform for conversion of atrial fibrillation: the results of an international randomized, double-blind multicenter trial. J Am Coll Cardiol. 2002; 39:1956-63.
PubMed
CrossRef
 
Khaykin Y, Newman D, Kowalewski M, Korley V, Dorian P. Biphasic versus monophasic cardioversion in shock-resistant atrial fibrillation. J Cardiovasc Electrophysiol. 2003; 14:868-72.
PubMed
CrossRef
 
Mortensen K, Risius T, Schwemer TF, Aydin MA, Köster R, Klemm HU, et al. Biphasic versus monophasic shock for external cardioversion of atrial flutter: a prospective, randomized trial. Cardiology. 2008; 111:57-62.
PubMed
CrossRef
 
Krittayaphong R, Raungrattanaamporn O, Bhuripanyo K, Sriratanasathavorn C, Pooranawattanakul S, Punlee K, et al. A randomized clinical trial of the efficacy of radiofrequency catheter ablation and amiodarone in the treatment of symptomatic atrial fibrillation. J Med Assoc Thai. 2003; 86:Suppl 1S8-16.
PubMed
 
Wazni OM, Marrouche NF, Martin DO, Verma A, Bhargava M, Saliba W, et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial. JAMA. 2005; 293:2634-40.
PubMed
CrossRef
 
Oral H, Pappone C, Chugh A, Good E, Bogun F, Pelosi F Jr, et al. Circumferential pulmonary-vein ablation for chronic atrial fibrillation. N Engl J Med. 2006; 354:934-41.
PubMed
CrossRef
 
Pappone C, Augello G, Sala S, Gugliotta F, Vicedomini G, Gulletta S, et al. A randomized trial of circumferential pulmonary vein ablation versus antiarrhythmic drug therapy in paroxysmal atrial fibrillation: the APAF Study. J Am Coll Cardiol. 2006; 48:2340-7.
PubMed
CrossRef
 
Stabile G, Bertaglia E, Senatore G, De Simone A, Zoppo F, Donnici G, et al. Catheter ablation treatment in patients with drug-refractory atrial fibrillation: a prospective, multi-centre, randomized, controlled study (Catheter Ablation For The Cure Of Atrial Fibrillation Study). Eur Heart J. 2006; 27:216-21.
PubMed
CrossRef
 
Jaïs P, Cauchemez B, Macle L, Daoud E, Khairy P, Subbiah R, et al. Catheter ablation versus antiarrhythmic drugs for atrial fibrillation: the A4 study. Circulation. 2008; 118:2498-505.
PubMed
CrossRef
 
Forleo GB, Mantica M, De Luca L, Leo R, Santini L, Panigada S, et al. Catheter ablation of atrial fibrillation in patients with diabetes mellitus type 2: results from a randomized study comparing pulmonary vein isolation versus antiarrhythmic drug therapy. J Cardiovasc Electrophysiol. 2009; 20:22-8.
PubMed
CrossRef
 
Wilber DJ, Pappone C, Neuzil P, DePaola A, Marchlinski F, Natale A, et al, ThermoCool AF Trial Investigators. Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial. JAMA. 2010; 303:333-40.
PubMed
CrossRef
 
Mont L, Bisbal F, Hernández-Madrid A, Pérez-Castellano N, Viñolas X, Arenal A, et al, SARA investigators. Catheter ablation vs. antiarrhythmic drug treatment of persistent atrial fibrillation: a multicentre, randomized, controlled trial (SARA study). Eur Heart J. 2014; 35:501-7.
PubMed
CrossRef
 
Budera P, Straka Z, Osmancík P, Vanek T, Jelínek Š, Hlavicka J, et al. Comparison of cardiac surgery with left atrial surgical ablation vs. cardiac surgery without atrial ablation in patients with coronary and/or valvular heart disease plus atrial fibrillation: final results of the PRAGUE-12 randomized multicentre study. Eur Heart J. 2012; 33:2644-52.
PubMed
CrossRef
 
Delle Karth G, Geppert A, Neunteufl T, Priglinger U, Haumer M, Gschwandtner M, et al. Amiodarone versus diltiazem for rate control in critically ill patients with atrial tachyarrhythmias. Crit Care Med. 2001; 29:1149-53.
PubMed
CrossRef
 
Demircan C, Cikriklar HI, Engindeniz Z, Cebicci H, Atar N, Guler V, et al. Comparison of the effectiveness of intravenous diltiazem and metoprolol in the management of rapid ventricular rate in atrial fibrillation. Emerg Med J. 2005; 22:411-4.
PubMed
CrossRef
 
Hofmann R, Steinwender C, Kammler J, Kypta A, Leisch F. Effects of a high dose intravenous bolus amiodarone in patients with atrial fibrillation and a rapid ventricular rate. Int J Cardiol. 2006; 110:27-32.
PubMed
CrossRef
 
Khand AU, Rankin AC, Martin W, Taylor J, Gemmell I, Cleland JG. Carvedilol alone or in combination with digoxin for the management of atrial fibrillation in patients with heart failure? J Am Coll Cardiol. 2003; 42:1944-51.
PubMed
CrossRef
 
Kochiadakis GE, Kanoupakis EM, Kalebubas MD, Igoumenidis NE, Vardakis KE, Mavrakis HE, et al. Sotalol vs metoprolol for ventricular rate control in patients with chronic atrial fibrillation who have undergone digitalization: a single-blinded crossover study. Europace. 2001; 3:73-9.
PubMed
CrossRef
 
Siu CW, Lau CP, Lee WL, Lam KF, Tse HF. Intravenous diltiazem is superior to intravenous amiodarone or digoxin for achieving ventricular rate control in patients with acute uncomplicated atrial fibrillation. Crit Care Med. 2009; 37:2174-9.
PubMed
CrossRef
 
Capucci A, Villani GQ, Aschieri D, Rosi A, Piepoli MF. Oral amiodarone increases the efficacy of direct-current cardioversion in restoration of sinus rhythm in patients with chronic atrial fibrillation. Eur Heart J. 2000; 21:66-73.
PubMed
CrossRef
 
Hemels ME, Van Noord T, Crijns HJ, Van Veldhuisen DJ, Veeger NJ, Bosker HA, et al. Verapamil versus digoxin and acute versus routine serial cardioversion for the improvement of rhythm control for persistent atrial fibrillation. J Am Coll Cardiol. 2006; 48:1001-9.
PubMed
CrossRef
 
Holming K. The effect of digitalis or a beta-blocker, alone or in combination, on atrial fibrillation at rest and during exercise. Ups J Med Sci. 2001; 106:77-8.
PubMed
CrossRef
 
Lindholm CJ, Fredholm O, Möller SJ, Edvardsson N, Kronvall T, Pettersson T, et al. Sinus rhythm maintenance following DC cardioversion of atrial fibrillation is not improved by temporary precardioversion treatment with oral verapamil. Heart. 2004; 90:534-8.
PubMed
CrossRef
 
Simpson CS, Ghali WA, Sanfilippo AJ, Moritz S, Abdollah H. Clinical assessment of clonidine in the treatment of new-onset rapid atrial fibrillation: a prospective, randomized clinical trial. Am Heart J. 2001; 142:E3.
PubMed
CrossRef
 
Thomas SP, Guy D, Wallace E, Crampton R, Kijvanit P, Eipper V, et al. Rapid loading of sotalol or amiodarone for management of recent onset symptomatic atrial fibrillation: a randomized, digoxin-controlled trial. Am Heart J. 2004; 147:E3.
PubMed
CrossRef
 
Tsuneda T, Yamashita T, Fukunami M, Kumagai K, Niwano S, Okumura K, et al. Rate control and quality of life in patients with permanent atrial fibrillation: the Quality of Life and Atrial Fibrillation (QOLAF) Study. Circ J. 2006; 70:965-70.
PubMed
CrossRef
 
Wattanasuwan N, Khan IA, Mehta NJ, Arora P, Singh N, Vasavada BC, et al. Acute ventricular rate control in atrial fibrillation: IV combination of diltiazem and digoxin vs. IV diltiazem alone. Chest. 2001; 119:502-6.
PubMed
CrossRef
 
Ulimoen SR, Enger S, Carlson J, Platonov PG, Pripp AH, Abdelnoor M, et al. Comparison of four single-drug regimens on ventricular rate and arrhythmia-related symptoms in patients with permanent atrial fibrillation. Am J Cardiol. 2013; 111:225-30.
PubMed
CrossRef
 
Ulimoen SR, Enger S, Pripp AH, Abdelnoor M, Arnesen H, Gjesdal K, et al. Calcium channel blockers improve exercise capacity and reduce N-terminal Pro-B-type natriuretic peptide levels compared with beta-blockers in patients with permanent atrial fibrillation. Eur Heart J. 2014; 35:517-24.
PubMed
CrossRef
 
Van Gelder IC, Groenveld HF, Crijns HJ, Tuininga YS, Tijssen JG, Alings AM, et al, RACE II Investigators. Lenient versus strict rate control in patients with atrial fibrillation. N Engl J Med. 2010; 362:1363-73.
PubMed
CrossRef
 
Groenveld HF, Crijns HJ, Rienstra M, Van den Berg MP, Van Veldhuisen DJ, Van Gelder IC, RACE investigators. Does intensity of rate control influence outcome in persistent atrial fibrillation? Data of the RACE study. Am Heart J. 2009; 158:785-91.
PubMed
CrossRef
 
Van Gelder IC, Wyse DG, Chandler ML, Cooper HA, Olshansky B, Hagens VE, et al, RACE and AFFIRM Investigators. Does intensity of rate-control influence outcome in atrial fibrillation? An analysis of pooled data from the RACE and AFFIRM studies. Europace. 2006; 8:935-42.
PubMed
CrossRef
 
Levy T, Walker S, Mason M, Spurrell P, Rex S, Brant S, et al. Importance of rate control or rate regulation for improving exercise capacity and quality of life in patients with permanent atrial fibrillation and normal left ventricular function: a randomised controlled study. Heart. 2001; 85:171-8.
PubMed
CrossRef
 
Weerasooriya R, Davis M, Powell A, Szili-Torok T, Shah C, Whalley D, et al. The Australian Intervention Randomized Control of Rate in Atrial Fibrillation Trial (AIRCRAFT). J Am Coll Cardiol. 2003; 41:1697-702.
PubMed
CrossRef
 
Lee SH, Cheng JJ, Chen SA. A randomized, prospective comparison of anterior and posterior approaches to atrioventricular junction modification of medically refractory atrial fibrillation. Pacing Clin Electrophysiol. 2000; 23:966-74.
PubMed
CrossRef
 
Doshi RN, Daoud EG, Fellows C, Turk K, Duran A, Hamdan MH, et al, PAVE Study Group. Left ventricular-based cardiac stimulation post AV nodal ablation evaluation (the PAVE study). J Cardiovasc Electrophysiol. 2005; 16:1160-5.
PubMed
CrossRef
 
Kirkutis A, Poviliunas A, Griciene P, Polena S, Yang S, Yalamanchi G, et al. Cardiac rate normalization in chronic atrial fibrillation: comparison of long-term efficacy of treatment with amiodarone versus AV node ablation and permanent His-bundle pacing. Proc West Pharmacol Soc. 2004; 47:69-70.
PubMed
 
Balla I, Petrela E, Kondili A. Pharmacological conversion of recent atrial fibrillation: a randomized, placebo-controlled study of three antiarrhythmic drugs. Anadolu Kardiyol Derg. 2011; 11:600-6.
PubMed
 
Glover BM, Walsh SJ, McCann CJ, Moore MJ, Manoharan G, Dalzell GW, et al. Biphasic energy selection for transthoracic cardioversion of atrial fibrillation. The BEST AF Trial. Heart. 2008; 94:884-7.
PubMed
CrossRef
 
Joglar JA, Hamdan MH, Ramaswamy K, Zagrodzky JD, Sheehan CJ, Nelson LL, et al. Initial energy for elective external cardioversion of persistent atrial fibrillation. Am J Cardiol. 2000; 86:348-50.
PubMed
CrossRef
 
Kawabata VS, Vianna CB, Moretti MA, Gonzalez MM, Ferreira JF, Timerman S, et al. Monophasic versus biphasic waveform shocks for atrial fibrillation cardioversion in patients with concomitant amiodarone therapy. Europace. 2007; 9:143-6.
PubMed
CrossRef
 
Kirchhof P, Eckardt L, Loh P, Weber K, Fischer RJ, Seidl KH, et al. Anterior-posterior versus anterior-lateral electrode positions for external cardioversion of atrial fibrillation: a randomised trial. Lancet. 2002; 360:1275-9.
PubMed
CrossRef
 
Kirchhof P, Mönnig G, Wasmer K, Heinecke A, Breithardt G, Eckardt L, et al. A trial of self-adhesive patch electrodes and hand-held paddle electrodes for external cardioversion of atrial fibrillation (MOBIPAPA). Eur Heart J. 2005; 26:1292-7.
PubMed
CrossRef
 
Korantzopoulos P, Kolettis TM, Papathanasiou A, Naka KK, Kolios P, Leontaridis I, et al. Propafenone added to ibutilide increases conversion rates of persistent atrial fibrillation. Heart. 2006; 92:631-4.
PubMed
CrossRef
 
Nergårdh AK, Rosenqvist M, Nordlander R, Frick M. Maintenance of sinus rhythm with metoprolol CR initiated before cardioversion and repeated cardioversion of atrial fibrillation: a randomized double-blind placebo-controlled study. Eur Heart J. 2007; 28:1351-7.
PubMed
CrossRef
 
Singh BN, Singh SN, Reda DJ, Tang XC, Lopez B, Harris CL, et al, Sotalol Amiodarone Atrial Fibrillation Efficacy Trial (SAFE-T) Investigators. Amiodarone versus sotalol for atrial fibrillation. N Engl J Med. 2005; 352:1861-72.
PubMed
CrossRef
 
Vijayalakshmi K, Whittaker VJ, Sutton A, Campbell P, Wright RA, Hall JA, et al. A randomized trial of prophylactic antiarrhythmic agents (amiodarone and sotalol) in patients with atrial fibrillation for whom direct current cardioversion is planned. Am Heart J. 2006; 151:863.
PubMed
CrossRef
 
Alatawi F, Gurevitz O, White RD, Ammash NM, Malouf JF, Bruce CJ, et al. Prospective, randomized comparison of two biphasic waveforms for the efficacy and safety of transthoracic biphasic cardioversion of atrial fibrillation. Heart Rhythm. 2005; 2:382-7.
PubMed
CrossRef
 
Alp NJ, Rahman S, Bell JA, Shahi M. Randomised comparison of antero-lateral versus antero-posterior paddle positions for DC cardioversion of persistent atrial fibrillation. Int J Cardiol. 2000; 75:211-6.
PubMed
CrossRef
 
Ambler JJ, Deakin CD. A randomized controlled trial of efficacy and ST change following use of the Welch-Allyn MRL PIC biphasic waveform versus damped sine monophasic waveform for external DC cardioversion. Resuscitation. 2006; 71:146-51.
PubMed
CrossRef
 
Boodhoo L, Mitchell AR, Bordoli G, Lloyd G, Patel N, Sulke N. DC cardioversion of persistent atrial fibrillation: a comparison of two protocols. Int J Cardiol. 2007; 114:16-21.
PubMed
CrossRef
 
Boos C, Thomas MD, Jones A, Clarke E, Wilbourne G, More RS. Higher energy monophasic DC cardioversion for persistent atrial fibrillation: is it time to start at 360 joules? Ann Noninvasive Electrocardiol. 2003; 8:121-6.
PubMed
CrossRef
 
Brazdzionyte J, Babarskiene RM, Stanaitiene G. Anterior-posterior versus anterior-lateral electrode position for biphasic cardioversion of atrial fibrillation. Medicina (Kaunas). 2006; 42:994-8.
PubMed
 
Fragakis N, Bikias A, Delithanasis I, Konstantinidou M, Liakopoulos N, Kozirakis M, et al. Acute beta-adrenoceptor blockade improves efficacy of ibutilide in conversion of atrial fibrillation with a rapid ventricular rate. Europace. 2009; 11:70-4.
PubMed
CrossRef
 
Hassan S, Slim AM, Ahmad S, Kamalakannan D, Khoury R, Kakish E, et al. Conversion of atrial fibrillation to sinus rhythm during treatment with intravenous esmolol or diltiazem: a prospective, randomized comparison. J Cardiovasc Pharmacol Ther. 2007; 12:227-31.
PubMed
CrossRef
 
Joseph AP, Ward MR. A prospective, randomized controlled trial comparing the efficacy and safety of sotalol, amiodarone, and digoxin for the reversion of new-onset atrial fibrillation. Ann Emerg Med. 2000; 36:1-9.
PubMed
CrossRef
 
Kafkas NV, Patsilinakos SP, Mertzanos GA, Papageorgiou KI, Chaveles JI, Dagadaki OK, et al. Conversion efficacy of intravenous ibutilide compared with intravenous amiodarone in patients with recent-onset atrial fibrillation and atrial flutter. Int J Cardiol. 2007; 118:321-5.
PubMed
CrossRef
 
Kanoupakis EM, Manios EG, Mavrakis HE, Tzerakis PG, Mouloudi HK, Vardas PE. Comparative effects of carvedilol and amiodarone on conversion and recurrence rates of persistent atrial fibrillation. Am J Cardiol. 2004; 94:659-62.
PubMed
CrossRef
 
Manios EG, Mavrakis HE, Kanoupakis EM, Kallergis EM, Dermitzaki DN, Kambouraki DC, et al. Effects of amiodarone and diltiazem on persistent atrial fibrillation conversion and recurrence rates: a randomized controlled study. Cardiovasc Drugs Ther. 2003; 17:31-9.
PubMed
CrossRef
 
Marinsek M, Larkin GL, Zohar P, Bervar M, Pekolj-Bicanic M, Mocnik FS, et al. Efficacy and impact of monophasic versus biphasic countershocks for transthoracic cardioversion of persistent atrial fibrillation. Am J Cardiol. 2003; 92:988-91.
PubMed
CrossRef
 
Mazzocca G, Corbucci G, Venturini E, Becuzzi L. Is pretreatment with ibutilide useful for atrial fibrillation cardioversion when combined with biphasic shock? J Cardiovasc Med (Hagerstown). 2006; 7:124-8.
PubMed
CrossRef
 
Rashba EJ, Bouhouch R, MacMurdy KA, Shorofsky SR, Peters RW, Gold MR. Effect of shock polarity on the efficacy of transthoracic atrial defibrillation. Am Heart J. 2002; 143:541-5.
PubMed
CrossRef
 
Rashba EJ, Gold MR, Crawford FA, Leman RB, Peters RW, Shorofsky SR. Efficacy of transthoracic cardioversion of atrial fibrillation using a biphasic, truncated exponential shock waveform at variable initial shock energies. Am J Cardiol. 2004; 94:1572-4.
PubMed
CrossRef
 
Redfearn DP, Skanes AC, Lane J, Stafford PJ. Signal-averaged P wave reflects change in atrial electrophysiological substrate afforded by verapamil following cardioversion from atrial fibrillation. Pacing Clin Electrophysiol. 2006; 29:1089-95.
PubMed
CrossRef
 
Scholten M, Szili-Torok T, Klootwijk P, Jordaens L. Comparison of monophasic and biphasic shocks for transthoracic cardioversion of atrial fibrillation. Heart. 2003; 89:1032-4.
PubMed
CrossRef
 
Siaplaouras S, Buob A, Rötter C, Böhm M, Jung J. Randomized comparison of anterolateral versus anteroposterior electrode position for biphasic external cardioversion of atrial fibrillation. Am Heart J. 2005; 150:150-2.
PubMed
CrossRef
 
Siaplaouras S, Buob A, Rötter C, Böhm M, Jung J. Impact of biphasic electrical cardioversion of atrial fibrillation on early recurrent atrial fibrillation and shock efficacy. J Cardiovasc Electrophysiol. 2004; 15:895-7.
PubMed
CrossRef
 
Villani GQ, Piepoli MF, Terracciano C, Capucci A. Effects of diltiazem pretreatment on direct-current cardioversion in patients with persistent atrial fibrillation: a single-blind, randomized, controlled study. Am Heart J. 2000; 140:e12.
PubMed
CrossRef
 
Chen WS, Gao BR, Chen WQ, Li ZZ, Xu ZY, Zhang YH, et al. Comparison of pharmacological and electrical cardioversion in permanent atrial fibrillation after prosthetic cardiac valve replacement: a prospective randomized trial. J Int Med Res. 2013; 41:1067-73.
PubMed
CrossRef
 
Deakin CD, Connelly S, Wharton R, Yuen HM. A comparison of rectilinear and truncated exponential biphasic waveforms in elective cardioversion of atrial fibrillation: a prospective randomized controlled trial. Resuscitation. 2013; 84:286-91.
PubMed
CrossRef
 
De Simone A, Turco P, De Matteis C, La Rocca V, Nocerino P, Greco L, et al. Effect of verapamil on secondary cardioversion in patients with early atrial fibrillation recurrence after electrical cardioversion. Am J Cardiol. 2002; 90:185-7.
PubMed
CrossRef
 
Van Noord T, Van Gelder IC, Tieleman RG, Bosker HA, Tuinenburg AE, Volkers C, et al. VERDICT: the Verapamil versus Digoxin Cardioversion Trial: a randomized study on the role of calcium lowering for maintenance of sinus rhythm after cardioversion of persistent atrial fibrillation. J Cardiovasc Electrophysiol. 2001; 12:766-9.
PubMed
CrossRef
 
Bittner A, Mönnig G, Zellerhoff S, Pott C, Köbe J, Dechering D, et al. Randomized study comparing duty-cycled bipolar and unipolar radiofrequency with point-by-point ablation in pulmonary vein isolation. Heart Rhythm. 2011; 8:1383-90.
PubMed
CrossRef
 
Blomström-Lundqvist C, Johansson B, Berglin E, Nilsson L, Jensen SM, Thelin S, et al. A randomized double-blind study of epicardial left atrial cryoablation for permanent atrial fibrillation in patients undergoing mitral valve surgery: the SWEDish Multicentre Atrial Fibrillation study (SWEDMAF). Eur Heart J. 2007; 28:2902-8.
PubMed
CrossRef
 
Boersma LV, Castella M, van Boven W, Berruezo A, Yilmaz A, Nadal M, et al. Atrial fibrillation catheter ablation versus surgical ablation treatment (FAST): a 2-center randomized clinical trial. Circulation. 2012; 125:23-30.
PubMed
CrossRef
 
Bulava A, Haniš J, Sitek D, Ošmera O, Karpianus D, Snorek M, et al. Catheter ablation for paroxysmal atrial fibrillation: a randomized comparison between multielectrode catheter and point-by-point ablation. Pacing Clin Electrophysiol. 2010; 33:1039-46.
PubMed
CrossRef
 
Calò L, Lamberti F, Loricchio ML, De Ruvo E, Colivicchi F, Bianconi L, et al. Left atrial ablation versus biatrial ablation for persistent and permanent atrial fibrillation: a prospective and randomized study. J Am Coll Cardiol. 2006; 47:2504-12.
PubMed
CrossRef
 
Chevalier P, Leizorovicz A, Maureira P, Carteaux JP, Corbineau H, Caus T, et al. Left atrial radiofrequency ablation during mitral valve surgery: a prospective randomized multicentre study (SAFIR). Arch Cardiovasc Dis. 2009; 102:769-75.
PubMed
CrossRef
 
Deisenhofer I, Estner H, Reents T, Fichtner S, Bauer A, Wu J, et al. Does electrogram guided substrate ablation add to the success of pulmonary vein isolation in patients with paroxysmal atrial fibrillation? A prospective, randomized study. J Cardiovasc Electrophysiol. 2009; 20:514-21.
PubMed
CrossRef
 
Deneke T, Khargi K, Grewe PH, Laczkovics A, von Dryander S, Lawo T, et al. Efficacy of an additional MAZE procedure using cooled-tip radiofrequency ablation in patients with chronic atrial fibrillation and mitral valve disease. A randomized, prospective trial. Eur Heart J. 2002; 23:558-66.
PubMed
CrossRef
 
Di Biase L, Elayi CS, Fahmy TS, Martin DO, Ching CK, Barrett C, et al. Atrial fibrillation ablation strategies for paroxysmal patients: randomized comparison between different techniques. Circ Arrhythm Electrophysiol. 2009; 2:113-9.
PubMed
CrossRef
 
Dixit S, Marchlinski FE, Lin D, Callans DJ, Bala R, Riley MP, et al. Randomized ablation strategies for the treatment of persistent atrial fibrillation: RASTA study. Circ Arrhythm Electrophysiol. 2012; 5:287-94.
PubMed
CrossRef
 
Dixit S, Gerstenfeld EP, Callans DJ, Cooper JM, Lin D, Russo AM, et al. Comparison of cool tip versus 8-mm tip catheter in achieving electrical isolation of pulmonary veins for long-term control of atrial fibrillation: a prospective randomized pilot study. J Cardiovasc Electrophysiol. 2006; 17:1074-9.
PubMed
CrossRef
 
Dixit S, Gerstenfeld EP, Ratcliffe SJ, Cooper JM, Russo AM, Kimmel SE, et al. Single procedure efficacy of isolating all versus arrhythmogenic pulmonary veins on long-term control of atrial fibrillation: a prospective randomized study. Heart Rhythm. 2008; 5:174-81.
PubMed
CrossRef
 
Doukas G, Samani NJ, Alexiou C, Oc M, Chin DT, Stafford PG, et al. Left atrial radiofrequency ablation during mitral valve surgery for continuous atrial fibrillation: a randomized controlled trial. JAMA. 2005; 294:2323-9.
PubMed
CrossRef
 
Elayi CS, Verma A, Di Biase L, Ching CK, Patel D, Barrett C, et al. Ablation for longstanding permanent atrial fibrillation: results from a randomized study comparing three different strategies. Heart Rhythm. 2008; 5:1658-64.
PubMed
CrossRef
 
Fiala M, Chovancík J, Nevralová R, Neuwirth R, Jiravský O, Nykl I, et al. Pulmonary vein isolation using segmental versus electroanatomical circumferential ablation for paroxysmal atrial fibrillation: over 3-year results of a prospective randomized study. J Interv Card Electrophysiol. 2008; 22:13-21.
PubMed
CrossRef
 
Khaykin Y, Skanes A, Champagne J, Themistoclakis S, Gula L, Rossillo A, et al. A randomized controlled trial of the efficacy and safety of electroanatomic circumferential pulmonary vein ablation supplemented by ablation of complex fractionated atrial electrograms versus potential-guided pulmonary vein antrum isolation guided by intracardiac ultrasound. Circ Arrhythm Electrophysiol. 2009; 2:481-7.
PubMed
CrossRef
 
Pontoppidan J, Nielsen JC, Poulsen SH, Jensen HK, Walfridsson H, Pedersen AK, et al. Prophylactic cavotricuspid isthmus block during atrial fibrillation ablation in patients without atrial flutter: a randomised controlled trial. Heart. 2009; 95:994-9.
PubMed
CrossRef
 
Roux JF, Zado E, Callans DJ, Garcia F, Lin D, Marchlinski FE, et al. Antiarrhythmics After Ablation of Atrial Fibrillation (5A Study). Circulation. 2009; 120:1036-40.
PubMed
CrossRef
 
Srivastava V, Kumar S, Javali S, Rajesh TR, Pai V, Khandekar J, et al. Efficacy of three different ablative procedures to treat atrial fibrillation in patients with valvular heart disease: a randomised trial. Heart Lung Circ. 2008; 17:232-40.
PubMed
CrossRef
 
Tamborero D, Mont L, Berruezo A, Matiello M, Benito B, Sitges M, et al. Left atrial posterior wall isolation does not improve the outcome of circumferential pulmonary vein ablation for atrial fibrillation: a prospective randomized study. Circ Arrhythm Electrophysiol. 2009; 2:35-40.
PubMed
CrossRef
 
Turco P, De Simone A, La Rocca V, Iuliano A, Capuano V, Astarita C, et al. Antiarrhythmic drug therapy after radiofrequency catheter ablation in patients with atrial fibrillation. Pacing Clin Electrophysiol. 2007; 30:Suppl 1S112-5.
PubMed
CrossRef
 
Van Breugel HN, Nieman FH, Accord RE, Van Mastrigt GA, Nijs JF, Severens JL, et al. A prospective randomized multicenter comparison on health-related quality of life: the value of add-on arrhythmia surgery in patients with paroxysmal, permanent or persistent atrial fibrillation undergoing valvular and/or coronary bypass surgery. J Cardiovasc Electrophysiol. 2010; 21:511-20.
PubMed
CrossRef
 
Verma A, Mantovan R, Macle L, De Martino G, Chen J, Morillo CA, et al. Substrate and Trigger Ablation for Reduction of Atrial Fibrillation (STAR AF): a randomized, multicentre, international trial. Eur Heart J. 2010; 31:1344-56.
PubMed
CrossRef
 
von Oppell UO, Masani N, O'Callaghan P, Wheeler R, Dimitrakakis G, Schiffelers S. Mitral valve surgery plus concomitant atrial fibrillation ablation is superior to mitral valve surgery alone with an intensive rhythm control strategy. Eur J Cardiothorac Surg. 2009; 35:641-50.
PubMed
CrossRef
 
Wang J, Meng X, Li H, Cui Y, Han J, Xu C. Prospective randomized comparison of left atrial and biatrial radiofrequency ablation in the treatment of atrial fibrillation. Eur J Cardiothorac Surg. 2009; 35:116-22.
PubMed
CrossRef
 
Willems S, Klemm H, Rostock T, Brandstrup B, Ventura R, Steven D, et al. Substrate modification combined with pulmonary vein isolation improves outcome of catheter ablation in patients with persistent atrial fibrillation: a prospective randomized comparison. Eur Heart J. 2006; 27:2871-8.
PubMed
CrossRef
 
Zhao X, Zhang J, Hu J, Liao D, Zhu Y, Mei X, et al. Pulmonary antrum radial-linear ablation for paroxysmal atrial fibrillation: interim analysis of a multicenter trial. Circ Arrhythm Electrophysiol. 2013; 6:310-7.
PubMed
CrossRef
 
Jonsson A, Lehto M, Ahn H, Hermansson U, Linde P, Ahlsson A, et al. Microwave ablation in mitral valve surgery for atrial fibrillation (MAMA). J Atr Fibrillation. 2012; 5:13-22.
 
Packer DL, Kowal RC, Wheelan KR, Irwin JM, Champagne J, Guerra PG, et al, STOP AF Cryoablation Investigators. Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American Arctic Front (STOP AF) pivotal trial. J Am Coll Cardiol. 2013; 61:1713-23.
PubMed
CrossRef
 
Fichtner S, Hessling G, Ammar S, Reents T, Estner HL, Jilek C, et al. A prospective randomized study comparing isolation of the arrhythmogenic vein versus all veins in paroxysmal atrial fibrillation. Clin Cardiol. 2013; 36:422-6.
PubMed
CrossRef
 
Abreu Filho CA, Lisboa LA, Dallan LA, Spina GS, Grinberg M, Scanavacca M, et al. Effectiveness of the maze procedure using cooled-tip radiofrequency ablation in patients with permanent atrial fibrillation and rheumatic mitral valve disease. Circulation. 2005; 112:I20-5.
PubMed
 
Akpinar B, Guden M, Sagbas E, Sanisoglu I, Ozbek U, Caynak B, et al. Combined radiofrequency modified maze and mitral valve procedure through a port access approach: early and mid-term results. Eur J Cardiothorac Surg. 2003; 24:223-30.
PubMed
CrossRef
 
Albrecht A, Kalil RA, Schuch L, Abrahão R, Sant'Anna JR, de Lima G, et al. Randomized study of surgical isolation of the pulmonary veins for correction of permanent atrial fibrillation associated with mitral valve disease. J Thorac Cardiovasc Surg. 2009; 138:454-9.
PubMed
CrossRef
 
Arentz T, Weber R, Bürkle G, Herrera C, Blum T, Stockinger J, et al. Small or large isolation areas around the pulmonary veins for the treatment of atrial fibrillation? Results from a prospective randomized study. Circulation. 2007; 115:3057-63.
PubMed
CrossRef
 
Chen M, Yang B, Chen H, Ju W, Zhang F, Tse HF, et al. Randomized comparison between pulmonary vein antral isolation versus complex fractionated electrogram ablation for paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2011; 22:973-81.
PubMed
CrossRef
 
Corrado A, Bonso A, Madalosso M, Rossillo A, Themistoclakis S, Di Biase L, et al. Impact of systematic isolation of superior vena cava in addition to pulmonary vein antrum isolation on the outcome of paroxysmal, persistent, and permanent atrial fibrillation ablation: results from a randomized study. J Cardiovasc Electrophysiol. 2010; 21:1-5.
PubMed
CrossRef
 
de Lima GG, Kalil RA, Leiria TL, Hatem DM, Kruse CL, Abrahão R, et al. Randomized study of surgery for patients with permanent atrial fibrillation as a result of mitral valve disease. Ann Thorac Surg. 2004; 77:2089-94.
PubMed
CrossRef
 
Fassini G, Riva S, Chiodelli R, Trevisi N, Berti M, Carbucicchio C, et al. Left mitral isthmus ablation associated with PV isolation: long-term results of a prospective randomized study. J Cardiovasc Electrophysiol. 2005; 16:1150-6.
PubMed
CrossRef
 
Gaita F, Caponi D, Scaglione M, Montefusco A, Corleto A, Di Monte F, et al. Long-term clinical results of 2 different ablation strategies in patients with paroxysmal and persistent atrial fibrillation. Circ Arrhythm Electrophysiol. 2008; 1:269-75.
PubMed
CrossRef
 
Gavin AR, Singleton CB, Bowyer J, McGavigan AD. Pulmonary venous isolation versus additional substrate modification as treatment for paroxysmal atrial fibrillation. J Interv Card Electrophysiol. 2012; 33:101-7.
PubMed
CrossRef
 
Jessurun ER, van Hemel NM, Defauw JJ, Brutel De La Rivière A, Stofmeel MA, Kelder JC, et al. A randomized study of combining maze surgery for atrial fibrillation with mitral valve surgery. J Cardiovasc Surg (Torino). 2003; 44:9-18.
PubMed
 
Katritsis DG, Ellenbogen KA, Panagiotakos DB, Giazitzoglou E, Karabinos I, Papadopoulos A, et al. Ablation of superior pulmonary veins compared to ablation of all four pulmonary veins:. J Cardiovasc Electrophysiol. 2004; 15:641-5.
PubMed
CrossRef
 
Kim YH, Lim HE, Pak HN, Kwak JJ, Park JS, Choi JI, et al. Role of residual potentials inside circumferential pulmonary veins ablation lines in the recurrence of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2010; 21:959-65.
PubMed
CrossRef
 
Liu X, Tan HW, Wang XH, Shi HF, Li YZ, Li F, et al. Efficacy of catheter ablation and surgical CryoMaze procedure in patients with long-lasting persistent atrial fibrillation and rheumatic heart disease: a randomized trial. Eur Heart J. 2010; 31:2633-41.
PubMed
CrossRef
 
Liu X, Long D, Dong J, Hu F, Yu R, Tang R, et al. Is circumferential pulmonary vein isolation preferable to stepwise segmental pulmonary vein isolation for patients with paroxysmal atrial fibrillation? Circ J. 2006; 70:1392-7.
PubMed
CrossRef
 
Nilsson B, Chen X, Pehrson S, Køber L, Hilden J, Svendsen JH. Recurrence of pulmonary vein conduction and atrial fibrillation after pulmonary vein isolation for atrial fibrillation: a randomized trial of the ostial versus the extraostial ablation strategy. Am Heart J. 2006; 152:537.e1-8.
PubMed
CrossRef
 
Oral H, Chugh A, Good E, Igic P, Elmouchi D, Tschopp DR, et al. Randomized comparison of encircling and nonencircling left atrial ablation for chronic atrial fibrillation. Heart Rhythm. 2005; 2:1165-72.
PubMed
CrossRef
 
Oral H, Chugh A, Lemola K, Cheung P, Hall B, Good E, et al. Noninducibility of atrial fibrillation as an end point of left atrial circumferential ablation for paroxysmal atrial fibrillation: a randomized study. Circulation. 2004; 110:2797-801.
PubMed
CrossRef
 
Pires LM, Leiria TL, de Lima GG, Kruse ML, Nesralla IA, Kalil RA. Comparison of surgical cut and sew versus radiofrequency pulmonary veins isolation for chronic permanent atrial fibrillation: a randomized study. Pacing Clin Electrophysiol. 2010; 33:1249-57.
PubMed
CrossRef
 
Schuetz A, Schulze CJ, Sarvanakis KK, Mair H, Plazer H, Kilger E, et al. Surgical treatment of permanent atrial fibrillation using microwave energy ablation: a prospective randomized clinical trial. Eur J Cardiothorac Surg. 2003; 24:475-80.
PubMed
CrossRef
 
Sheikh I, Krum D, Cooley R, Dhala A, Blanck Z, Bhatia A, et al. Pulmonary vein isolation and linear lesions in atrial fibrillation ablation. J Interv Card Electrophysiol. 2006; 17:103-9.
PubMed
CrossRef
 
Wazni O, Marrouche NF, Martin DO, Gillinov AM, Saliba W, Saad E, et al. Randomized study comparing combined pulmonary vein-left atrial junction disconnection and cavotricuspid isthmus ablation versus pulmonary vein-left atrial junction disconnection alone in patients presenting with typical atrial flutter and atrial fibrillation. Circulation. 2003; 108:2479-83.
PubMed
CrossRef
 
Knaut M, Kolberg S, Brose S, Jung F. Epicardial microwave ablation of permanent atrial fibrillation during a coronary bypass and/or aortic valve operation: prospective, randomised, controlled, mono-centric study. Appl Cardiopulm Pathophysiol. 2010; 14:220-8.
 
Karch MR, Zrenner B, Deisenhofer I, Schreieck J, Ndrepepa G, Dong J, et al. Freedom from atrial tachyarrhythmias after catheter ablation of atrial fibrillation: a randomized comparison between 2 current ablation strategies. Circulation. 2005; 111:2875-80.
PubMed
CrossRef
 
Oral H, Chugh A, Yoshida K, Sarrazin JF, Kuhne M, Crawford T, et al. A randomized assessment of the incremental role of ablation of complex fractionated atrial electrograms after antral pulmonary vein isolation for long-lasting persistent atrial fibrillation. J Am Coll Cardiol. 2009; 53:782-9.
PubMed
CrossRef
 
Oral H, Chugh A, Good E, Crawford T, Sarrazin JF, Kuhne M, et al. Randomized evaluation of right atrial ablation after left atrial ablation of complex fractionated atrial electrograms for long-lasting persistent atrial fibrillation. Circ Arrhythm Electrophysiol. 2008; 1:6-13.
PubMed
CrossRef
 
Mun HS, Joung B, Shim J, Hwang HJ, Kim JY, Lee MH, et al. Does additional linear ablation after circumferential pulmonary vein isolation improve clinical outcome in patients with paroxysmal atrial fibrillation? Prospective randomised study. Heart. 2012; 98:480-4.
PubMed
CrossRef
 
Sawhney N, Anousheh R, Chen W, Feld GK. Circumferential pulmonary vein ablation with additional linear ablation results in an increased incidence of left atrial flutter compared with segmental pulmonary vein isolation as an initial approach to ablation of paroxysmal atrial fibrillation. Circ Arrhythm Electrophysiol. 2010; 3:243-8.
PubMed
CrossRef
 
Hocini M, Jaïs P, Sanders P, Takahashi Y, Rotter M, Rostock T, et al. Techniques, evaluation, and consequences of linear block at the left atrial roof in paroxysmal atrial fibrillation: a prospective randomized study. Circulation. 2005; 112:3688-96.
PubMed
CrossRef
 
Haïssaguerre M, Sanders P, Hocini M, Hsu LF, Shah DC, Scavée C, et al. Changes in atrial fibrillation cycle length and inducibility during catheter ablation and their relation to outcome. Circulation. 2004; 109:3007-13.
PubMed
CrossRef
 
Wang XH, Liu X, Sun YM, Shi HF, Zhou L, Gu JN. Pulmonary vein isolation combined with superior vena cava isolation for atrial fibrillation ablation: a prospective randomized study. Europace. 2008; 10:600-5.
PubMed
CrossRef
 
Wang YL, Liu X, Tan HW, Zhou L, Jiang WF, Gu J, et al. Evaluation of linear lesions in the left and right atrium in ablation of long-standing atrial fibrillation. Pacing Clin Electrophysiol. 2013; 36:1202-10.
PubMed
CrossRef
 
Bogun F, Bender B, Li YG, Hohnloser SH. Ablation of atypical atrial flutter guided by the use of concealed entrainment in patients without prior cardiac surgery. J Cardiovasc Electrophysiol. 2000; 11:136-45.
PubMed
CrossRef
 
Katritsis DG, Panagiotakos DB, Karvouni E, Giazitzoglou E, Korovesis S, Paxinos G, et al. Comparison of effectiveness of carvedilol versus bisoprolol for maintenance of sinus rhythm after cardioversion of persistent atrial fibrillation. Am J Cardiol. 2003; 92:1116-9.
PubMed
CrossRef
 
Le Heuzey JY, De Ferrari GM, Radzik D, Santini M, Zhu J, Davy JM. A short-term, randomized, double-blind, parallel-group study to evaluate the efficacy and safety of dronedarone versus amiodarone in patients with persistent atrial fibrillation: the DIONYSOS study. J Cardiovasc Electrophysiol. 2010; 21:597-605.
PubMed
CrossRef
 
Roy D, Talajic M, Dorian P, Connolly S, Eisenberg MJ, Green M, et al. Amiodarone to prevent recurrence of atrial fibrillation. Canadian Trial of Atrial Fibrillation Investigators. N Engl J Med. 2000; 342:913-20.
PubMed
CrossRef
 
AFFIRM First Antiarrhythmic Drug Substudy Investigators. Maintenance of sinus rhythm in patients with atrial fibrillation: an AFFIRM substudy of the first antiarrhythmic drug. J Am Coll Cardiol. 2003; 42:20-9.
PubMed
CrossRef
 
Bellandi F, Simonetti I, Leoncini M, Frascarelli F, Giovannini T, Maioli M, et al. Long-term efficacy and safety of propafenone and sotalol for the maintenance of sinus rhythm after conversion of recurrent symptomatic atrial fibrillation. Am J Cardiol. 2001; 88:640-5.
PubMed
CrossRef
 
De Simone A, De Pasquale M, De Matteis C, Canciello M, Manzo M, Sabino L, et al. VErapamil plus antiarrhythmic drugs reduce atrial fibrillation recurrences after an electrical cardioversion (VEPARAF Study). Eur Heart J. 2003; 24:1425-9.
PubMed
CrossRef
 
Kochiadakis GE, Igoumenidis NE, Hamilos ME, Tzerakis PG, Klapsinos NC, Chlouverakis GI, et al. Sotalol versus propafenone for long-term maintenance of normal sinus rhythm in patients with recurrent symptomatic atrial fibrillation. Am J Cardiol. 2004; 94:1563-6.
PubMed
CrossRef
 
Kochiadakis GE, Igoumenidis NE, Hamilos MI, Tzerakis PG, Klapsinos NC, Zacharis EA, et al. Long-term maintenance of normal sinus rhythm in patients with current symptomatic atrial fibrillation: amiodarone vs propafenone, both in low doses. Chest. 2004; 125:377-83.
PubMed
CrossRef
 
Kochiadakis GE, Igoumenidis NE, Marketou ME, Kaleboubas MD, Simantirakis EN, Vardas PE. Low dose amiodarone and sotalol in the treatment of recurrent, symptomatic atrial fibrillation: a comparative, placebo controlled study. Heart. 2000; 84:251-7.
PubMed
CrossRef
 
Kochiadakis GE, Marketou ME, Igoumenidis NE, Chrysostomakis SI, Mavrakis HE, Kaleboubas MD, et al. Amiodarone, sotalol, or propafenone in atrial fibrillation: which is preferred to maintain normal sinus rhythm? Pacing Clin Electrophysiol. 2000; 23:1883-7.
PubMed
CrossRef
 
Plewan A, Lehmann G, Ndrepepa G, Schreieck J, Alt EU, Schömig A, et al. Maintenance of sinus rhythm after electrical cardioversion of persistent atrial fibrillation; sotalol vs bisoprolol. Eur Heart J. 2001; 22:1504-10.
PubMed
CrossRef
 
Bertaglia E, D'Este D, Zerbo F, Zoppo F, Delise P, Pascotto P. Success of serial external electrical cardioversion of persistent atrial fibrillation in maintaining sinus rhythm; a randomized study. Eur Heart J. 2002; 23:1522-8.
PubMed
CrossRef
 
Ionescu-Ittu R, Abrahamowicz M, Jackevicius CA, Essebag V, Eisenberg MJ, Wynant W, et al. Comparative effectiveness of rhythm control vs rate control drug treatment effect on mortality in patients with atrial fibrillation. Arch Intern Med. 2012; 172:997-1004.
PubMed
CrossRef
 
Cosedis Nielsen J, Johannessen A, Raatikainen P, Hindricks G, Walfridsson H, Kongstad O, et al. Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation. N Engl J Med. 2012; 367:1587-95.
PubMed
CrossRef
 

Figures

Grahic Jump Location
Figure 1.

Summary of evidence search and selection.

AAD = antiarrhythmic drug; CRT = cardiac resynchronization therapy; RCT = randomized, controlled trial.

* Some studies were relevant to more than 1 topic.

Grahic Jump Location
Grahic Jump Location
Figure 2.

Meta-analysis forest plots.

AAD = antiarrhythmic drug; PVI = pulmonary vein isolation. A. All-cause mortality for rate- vs. rhythm-control strategies. B. Cardiovascular mortality for rate- vs. rhythm-control strategies. C. Stroke for rate- vs. rhythm-control strategies. D. Restoration of sinus rhythm for monophasic vs. biphasic waveforms. E. Maintenance of sinus rhythm for PVI vs. AAD therapy.

Grahic Jump Location

Tables

Table Jump PlaceholderTable 1. Summary of SOE and Effect Estimates for Rate- Versus Rhythm-Control Strategies 
Table Jump PlaceholderTable 2. Summary of SOE and Effect Estimates for Medications Used for Ventricular Rate Control 
Table Jump PlaceholderTable 3. Summary of SOE and Effect Estimates for Electrical Cardioversion and Antiarrhythmic Medications for Rhythm Control 
Table Jump PlaceholderAppendix Table. Summary of SOE and Effect Estimates for Procedural Rhythm-Control Therapies 

References

Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001; 285:2370-5.
PubMed
CrossRef
 
Krahn AD, Manfreda J, Tate RB, Mathewson FA, Cuddy TE. The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study. Am J Med. 1995; 98:476-84.
PubMed
CrossRef
 
Poole-Wilson PA, Swedberg K, Cleland JG, Di Lenarda A, Hanrath P, Komajda M, et al, Carvedilol Or Metoprolol European Trial Investigators. Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial. Lancet. 2003; 362:7-13.
PubMed
CrossRef
 
Maggioni AP, Latini R, Carson PE, Singh SN, Barlera S, Glazer R, et al, Val-HeFT Investigators. Valsartan reduces the incidence of atrial fibrillation in patients with heart failure: results from the Valsartan Heart Failure Trial (Val-HeFT). Am Heart J. 2005; 149:548-57.
PubMed
CrossRef
 
Wang TJ, Larson MG, Levy D, Vasan RS, Leip EP, Wolf PA, et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation. 2003; 107:2920-5.
PubMed
CrossRef
 
Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991; 22:983-8.
PubMed
CrossRef
 
Singh SN, Tang XC, Singh BN, Dorian P, Reda DJ, Harris CL, et al, SAFE-T Investigators. Quality of life and exercise performance in patients in sinus rhythm versus persistent atrial fibrillation: a Veterans Affairs Cooperative Studies Program Substudy. J Am Coll Cardiol. 2006; 48:721-30.
PubMed
CrossRef
 
Dorian P, Jung W, Newman D, Paquette M, Wood K, Ayers GM, et al. The impairment of health-related quality of life in patients with intermittent atrial fibrillation: implications for the assessment of investigational therapy. J Am Coll Cardiol. 2000; 36:1303-9.
PubMed
CrossRef
 
Chung MK, Shemanski L, Sherman DG, Greene HL, Hogan DB, Kellen JC, et al, AFFIRM Investigators. Functional status in rate- versus rhythm-control strategies for atrial fibrillation: results of the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Functional Status Substudy. J Am Coll Cardiol. 2005; 46:1891-9.
PubMed
CrossRef
 
Hagens VE, Ranchor AV, Van Sonderen E, Bosker HA, Kamp O, Tijssen JG, et al, RACE Study Group. Effect of rate or rhythm control on quality of life in persistent atrial fibrillation. Results from the Rate Control Versus Electrical Cardioversion (RACE) Study. J Am Coll Cardiol. 2004; 43:241-7.
PubMed
CrossRef
 
Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al, American College of Cardiology. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 guidelines for the management of patients with atrial fibrillation) developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Europace. 2006; 8:651-745.
PubMed
CrossRef
 
Al-Khatib SM, Allen Lapointe N, Chatterjee R, Crowley MJ, Dupre ME, Kong DF, et al.  Treatment of Atrial Fibrillation. Comparative Effectiveness Review No. 119. (Prepared by the Duke Evidence-based Practice Center under contract no. 290-2007-10066-I.) AHRQ Publication No. 13-EHC095-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2013. Accessed at www.effectivehealthcare.ahrq.gov/ehc/products/358/1559/atrial-fibrillation-report-130628.pdf on 14 April 2014.
 
McNamara RL, Bass EB, Miller MR, Segal JB, Goodman SN, Kim NL, et al.  Management of New Onset Atrial Fibrillation. Evidence Report/Technology Assessment No. 12. (Prepared by the Johns Hopkins University Evidence-based Practice Center under contract no. 290-97-0006.) AHRQ Publication No. 01-E026. Rockville, MD: Agency for Healthcare Research and Quality; 2001. Accessed at www.ncbi.nlm.nih.gov/books/NBK33108 on 30 October 2012.
 
McNamara RL, Bass EB, Miller MR, Segal JB, Goodman SN, Kim NL, et al. Management of new onset atrial fibrillation. Evid Rep Technol Assess (Summ). 2000; 1-7.
PubMed
 
McNamara RL, Tamariz LJ, Segal JB, Bass EB. Management of atrial fibrillation: review of the evidence for the role of pharmacologic therapy, electrical cardioversion, and echocardiography. Ann Intern Med. 2003; 139:1018-33.
PubMed
CrossRef
 
Agency for Healthcare Research and Quality.  Methods Guide for Effectiveness and Comparative Effectiveness Reviews. Rockville, MD: Agency for Healthcare Research and Quality; 2014. Accessed at www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=318 on 31 October 2011.
 
Brignole M, Menozzi C, Gasparini M, Bongiorni MG, Botto GL, Ometto R, et al, PAF 2 Study Investigators. An evaluation of the strategy of maintenance of sinus rhythm by antiarrhythmic drug therapy after ablation and pacing therapy in patients with paroxysmal atrial fibrillation. Eur Heart J. 2002; 23:892-900.
PubMed
CrossRef
 
Carlsson J, Miketic S, Windeler J, Cuneo A, Haun S, Micus S, et al, STAF Investigators. Randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation: the Strategies of Treatment of Atrial Fibrillation (STAF) study. J Am Coll Cardiol. 2003; 41:1690-6.
PubMed
CrossRef
 
Hohnloser SH, Kuck KH, Lilienthal J. Rhythm or rate control in atrial fibrillation—Pharmacological Intervention in Atrial Fibrillation (PIAF): a randomised trial. Lancet. 2000; 356:1789-94.
PubMed
CrossRef
 
Okçün B, Yigit Z, Arat A, Küçükoglu SM. Comparison of rate and rhythm control in patients with atrial fibrillation and nonischemic heart failure. Jpn Heart J. 2004; 45:591-601.
PubMed
CrossRef
 
Opolski G, Torbicki A, Kosior DA, Szulc M, Wozakowska-Kaplon B, Kolodziej P, et al, Investigators of the Polish How to Treat Chronic Atrial Fibrillation Study. Rate control vs rhythm control in patients with nonvalvular persistent atrial fibrillation: the results of the Polish How to Treat Chronic Atrial Fibrillation (HOT CAFE) Study. Chest. 2004; 126:476-86.
PubMed
CrossRef
 
Petrac D, Radic B, Radeljic V, Hamel D, Filipovic J. Ventricular pacing vs dual chamber pacing in patients with persistent atrial fibrillation after atrioventricular node ablation: open randomized study. Croat Med J. 2005; 46:922-8.
PubMed
 
Shelton RJ, Clark AL, Goode K, Rigby AS, Houghton T, Kaye GC, et al. A randomised, controlled study of rate versus rhythm control in patients with chronic atrial fibrillation and heart failure: (CAFE-II Study). Heart. 2009; 95:924-30.
PubMed
CrossRef
 
Talajic M, Khairy P, Levesque S, Connolly SJ, Dorian P, Dubuc M, et al, AF-CHF Investigators. Maintenance of sinus rhythm and survival in patients with heart failure and atrial fibrillation. J Am Coll Cardiol. 2010; 55:1796-802.
PubMed
CrossRef
 
Van Gelder IC, Hagens VE, Bosker HA, Kingma JH, Kamp O, Kingma T, et al, Rate Control versus Electrical Cardioversion for Persistent Atrial Fibrillation Study Group. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med. 2002; 347:1834-40.
PubMed
CrossRef
 
Vora A, Karnad D, Goyal V, Naik A, Gupta A, Lokhandwala Y, et al. Control of heart rate versus rhythm in rheumatic atrial fibrillation: a randomized study. J Cardiovasc Pharmacol Ther. 2004; 9:65-73.
PubMed
CrossRef
 
Wyse DG, Waldo AL, DiMarco JP, Domanski MJ, Rosenberg Y, Schron EB, et al, Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002; 347:1825-33.
PubMed
CrossRef
 
Yildiz A, Yigit Z, Okcun B, Baskurt M, Ortak K, Kaya A, et al. Comparison of rate and rhythm control in hypertension patients with atrial fibrillation. Circ J. 2008; 72:705-8.
PubMed
CrossRef
 
Suman-Horduna I, Roy D, Frasure-Smith N, Talajic M, Lespérance F, Blondeau L, et al, AF-CHF Trial Investigators. Quality of life and functional capacity in patients with atrial fibrillation and congestive heart failure. J Am Coll Cardiol. 2013; 61:455-60.
PubMed
CrossRef
 
Khan MN, Jaïs P, Cummings J, Di Biase L, Sanders P, Martin DO, et al, PABA-CHF Investigators. Pulmonary-vein isolation for atrial fibrillation in patients with heart failure. N Engl J Med. 2008; 359:1778-85.
PubMed
CrossRef
 
MacDonald MR, Connelly DT, Hawkins NM, Steedman T, Payne J, Shaw M, et al. Radiofrequency ablation for persistent atrial fibrillation in patients with advanced heart failure and severe left ventricular systolic dysfunction: a randomised controlled trial. Heart. 2011; 97:740-7.
PubMed
CrossRef
 
Jones DG, Haldar SK, Hussain W, Sharma R, Francis DP, Rahman-Haley SL, et al. A randomized trial to assess catheter ablation versus rate control in the management of persistent atrial fibrillation in heart failure. J Am Coll Cardiol. 2013; 61:1894-903.
PubMed
CrossRef
 
Ricard P, Lévy S, Boccara G, Lakhal E, Bardy G. External cardioversion of atrial fibrillation: comparison of biphasic vs monophasic waveform shocks. Europace. 2001; 3:96-9.
PubMed
CrossRef
 
Page RL, Kerber RE, Russell JK, Trouton T, Waktare J, Gallik D, et al, BiCard Investigators. Biphasic versus monophasic shock waveform for conversion of atrial fibrillation: the results of an international randomized, double-blind multicenter trial. J Am Coll Cardiol. 2002; 39:1956-63.
PubMed
CrossRef
 
Khaykin Y, Newman D, Kowalewski M, Korley V, Dorian P. Biphasic versus monophasic cardioversion in shock-resistant atrial fibrillation. J Cardiovasc Electrophysiol. 2003; 14:868-72.
PubMed
CrossRef
 
Mortensen K, Risius T, Schwemer TF, Aydin MA, Köster R, Klemm HU, et al. Biphasic versus monophasic shock for external cardioversion of atrial flutter: a prospective, randomized trial. Cardiology. 2008; 111:57-62.
PubMed
CrossRef
 
Krittayaphong R, Raungrattanaamporn O, Bhuripanyo K, Sriratanasathavorn C, Pooranawattanakul S, Punlee K, et al. A randomized clinical trial of the efficacy of radiofrequency catheter ablation and amiodarone in the treatment of symptomatic atrial fibrillation. J Med Assoc Thai. 2003; 86:Suppl 1S8-16.
PubMed
 
Wazni OM, Marrouche NF, Martin DO, Verma A, Bhargava M, Saliba W, et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial. JAMA. 2005; 293:2634-40.
PubMed
CrossRef
 
Oral H, Pappone C, Chugh A, Good E, Bogun F, Pelosi F Jr, et al. Circumferential pulmonary-vein ablation for chronic atrial fibrillation. N Engl J Med. 2006; 354:934-41.
PubMed
CrossRef
 
Pappone C, Augello G, Sala S, Gugliotta F, Vicedomini G, Gulletta S, et al. A randomized trial of circumferential pulmonary vein ablation versus antiarrhythmic drug therapy in paroxysmal atrial fibrillation: the APAF Study. J Am Coll Cardiol. 2006; 48:2340-7.
PubMed
CrossRef
 
Stabile G, Bertaglia E, Senatore G, De Simone A, Zoppo F, Donnici G, et al. Catheter ablation treatment in patients with drug-refractory atrial fibrillation: a prospective, multi-centre, randomized, controlled study (Catheter Ablation For The Cure Of Atrial Fibrillation Study). Eur Heart J. 2006; 27:216-21.
PubMed
CrossRef
 
Jaïs P, Cauchemez B, Macle L, Daoud E, Khairy P, Subbiah R, et al. Catheter ablation versus antiarrhythmic drugs for atrial fibrillation: the A4 study. Circulation. 2008; 118:2498-505.
PubMed
CrossRef
 
Forleo GB, Mantica M, De Luca L, Leo R, Santini L, Panigada S, et al. Catheter ablation of atrial fibrillation in patients with diabetes mellitus type 2: results from a randomized study comparing pulmonary vein isolation versus antiarrhythmic drug therapy. J Cardiovasc Electrophysiol. 2009; 20:22-8.
PubMed
CrossRef
 
Wilber DJ, Pappone C, Neuzil P, DePaola A, Marchlinski F, Natale A, et al, ThermoCool AF Trial Investigators. Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial. JAMA. 2010; 303:333-40.
PubMed
CrossRef
 
Mont L, Bisbal F, Hernández-Madrid A, Pérez-Castellano N, Viñolas X, Arenal A, et al, SARA investigators. Catheter ablation vs. antiarrhythmic drug treatment of persistent atrial fibrillation: a multicentre, randomized, controlled trial (SARA study). Eur Heart J. 2014; 35:501-7.
PubMed
CrossRef
 
Budera P, Straka Z, Osmancík P, Vanek T, Jelínek Š, Hlavicka J, et al. Comparison of cardiac surgery with left atrial surgical ablation vs. cardiac surgery without atrial ablation in patients with coronary and/or valvular heart disease plus atrial fibrillation: final results of the PRAGUE-12 randomized multicentre study. Eur Heart J. 2012; 33:2644-52.
PubMed
CrossRef
 
Delle Karth G, Geppert A, Neunteufl T, Priglinger U, Haumer M, Gschwandtner M, et al. Amiodarone versus diltiazem for rate control in critically ill patients with atrial tachyarrhythmias. Crit Care Med. 2001; 29:1149-53.
PubMed
CrossRef
 
Demircan C, Cikriklar HI, Engindeniz Z, Cebicci H, Atar N, Guler V, et al. Comparison of the effectiveness of intravenous diltiazem and metoprolol in the management of rapid ventricular rate in atrial fibrillation. Emerg Med J. 2005; 22:411-4.
PubMed
CrossRef
 
Hofmann R, Steinwender C, Kammler J, Kypta A, Leisch F. Effects of a high dose intravenous bolus amiodarone in patients with atrial fibrillation and a rapid ventricular rate. Int J Cardiol. 2006; 110:27-32.
PubMed
CrossRef
 
Khand AU, Rankin AC, Martin W, Taylor J, Gemmell I, Cleland JG. Carvedilol alone or in combination with digoxin for the management of atrial fibrillation in patients with heart failure? J Am Coll Cardiol. 2003; 42:1944-51.
PubMed
CrossRef
 
Kochiadakis GE, Kanoupakis EM, Kalebubas MD, Igoumenidis NE, Vardakis KE, Mavrakis HE, et al. Sotalol vs metoprolol for ventricular rate control in patients with chronic atrial fibrillation who have undergone digitalization: a single-blinded crossover study. Europace. 2001; 3:73-9.
PubMed
CrossRef
 
Siu CW, Lau CP, Lee WL, Lam KF, Tse HF. Intravenous diltiazem is superior to intravenous amiodarone or digoxin for achieving ventricular rate control in patients with acute uncomplicated atrial fibrillation. Crit Care Med. 2009; 37:2174-9.
PubMed
CrossRef
 
Capucci A, Villani GQ, Aschieri D, Rosi A, Piepoli MF. Oral amiodarone increases the efficacy of direct-current cardioversion in restoration of sinus rhythm in patients with chronic atrial fibrillation. Eur Heart J. 2000; 21:66-73.
PubMed
CrossRef
 
Hemels ME, Van Noord T, Crijns HJ, Van Veldhuisen DJ, Veeger NJ, Bosker HA, et al. Verapamil versus digoxin and acute versus routine serial cardioversion for the improvement of rhythm control for persistent atrial fibrillation. J Am Coll Cardiol. 2006; 48:1001-9.
PubMed
CrossRef
 
Holming K. The effect of digitalis or a beta-blocker, alone or in combination, on atrial fibrillation at rest and during exercise. Ups J Med Sci. 2001; 106:77-8.
PubMed
CrossRef
 
Lindholm CJ, Fredholm O, Möller SJ, Edvardsson N, Kronvall T, Pettersson T, et al. Sinus rhythm maintenance following DC cardioversion of atrial fibrillation is not improved by temporary precardioversion treatment with oral verapamil. Heart. 2004; 90:534-8.
PubMed
CrossRef
 
Simpson CS, Ghali WA, Sanfilippo AJ, Moritz S, Abdollah H. Clinical assessment of clonidine in the treatment of new-onset rapid atrial fibrillation: a prospective, randomized clinical trial. Am Heart J. 2001; 142:E3.
PubMed
CrossRef
 
Thomas SP, Guy D, Wallace E, Crampton R, Kijvanit P, Eipper V, et al. Rapid loading of sotalol or amiodarone for management of recent onset symptomatic atrial fibrillation: a randomized, digoxin-controlled trial. Am Heart J. 2004; 147:E3.
PubMed
CrossRef
 
Tsuneda T, Yamashita T, Fukunami M, Kumagai K, Niwano S, Okumura K, et al. Rate control and quality of life in patients with permanent atrial fibrillation: the Quality of Life and Atrial Fibrillation (QOLAF) Study. Circ J. 2006; 70:965-70.
PubMed
CrossRef
 
Wattanasuwan N, Khan IA, Mehta NJ, Arora P, Singh N, Vasavada BC, et al. Acute ventricular rate control in atrial fibrillation: IV combination of diltiazem and digoxin vs. IV diltiazem alone. Chest. 2001; 119:502-6.
PubMed
CrossRef
 
Ulimoen SR, Enger S, Carlson J, Platonov PG, Pripp AH, Abdelnoor M, et al. Comparison of four single-drug regimens on ventricular rate and arrhythmia-related symptoms in patients with permanent atrial fibrillation. Am J Cardiol. 2013; 111:225-30.
PubMed
CrossRef
 
Ulimoen SR, Enger S, Pripp AH, Abdelnoor M, Arnesen H, Gjesdal K, et al. Calcium channel blockers improve exercise capacity and reduce N-terminal Pro-B-type natriuretic peptide levels compared with beta-blockers in patients with permanent atrial fibrillation. Eur Heart J. 2014; 35:517-24.
PubMed
CrossRef
 
Van Gelder IC, Groenveld HF, Crijns HJ, Tuininga YS, Tijssen JG, Alings AM, et al, RACE II Investigators. Lenient versus strict rate control in patients with atrial fibrillation. N Engl J Med. 2010; 362:1363-73.
PubMed
CrossRef
 
Groenveld HF, Crijns HJ, Rienstra M, Van den Berg MP, Van Veldhuisen DJ, Van Gelder IC, RACE investigators. Does intensity of rate control influence outcome in persistent atrial fibrillation? Data of the RACE study. Am Heart J. 2009; 158:785-91.
PubMed
CrossRef
 
Van Gelder IC, Wyse DG, Chandler ML, Cooper HA, Olshansky B, Hagens VE, et al, RACE and AFFIRM Investigators. Does intensity of rate-control influence outcome in atrial fibrillation? An analysis of pooled data from the RACE and AFFIRM studies. Europace. 2006; 8:935-42.
PubMed
CrossRef
 
Levy T, Walker S, Mason M, Spurrell P, Rex S, Brant S, et al. Importance of rate control or rate regulation for improving exercise capacity and quality of life in patients with permanent atrial fibrillation and normal left ventricular function: a randomised controlled study. Heart. 2001; 85:171-8.
PubMed
CrossRef
 
Weerasooriya R, Davis M, Powell A, Szili-Torok T, Shah C, Whalley D, et al. The Australian Intervention Randomized Control of Rate in Atrial Fibrillation Trial (AIRCRAFT). J Am Coll Cardiol. 2003; 41:1697-702.
PubMed
CrossRef
 
Lee SH, Cheng JJ, Chen SA. A randomized, prospective comparison of anterior and posterior approaches to atrioventricular junction modification of medically refractory atrial fibrillation. Pacing Clin Electrophysiol. 2000; 23:966-74.
PubMed
CrossRef
 
Doshi RN, Daoud EG, Fellows C, Turk K, Duran A, Hamdan MH, et al, PAVE Study Group. Left ventricular-based cardiac stimulation post AV nodal ablation evaluation (the PAVE study). J Cardiovasc Electrophysiol. 2005; 16:1160-5.
PubMed
CrossRef
 
Kirkutis A, Poviliunas A, Griciene P, Polena S, Yang S, Yalamanchi G, et al. Cardiac rate normalization in chronic atrial fibrillation: comparison of long-term efficacy of treatment with amiodarone versus AV node ablation and permanent His-bundle pacing. Proc West Pharmacol Soc. 2004; 47:69-70.
PubMed
 
Balla I, Petrela E, Kondili A. Pharmacological conversion of recent atrial fibrillation: a randomized, placebo-controlled study of three antiarrhythmic drugs. Anadolu Kardiyol Derg. 2011; 11:600-6.
PubMed
 
Glover BM, Walsh SJ, McCann CJ, Moore MJ, Manoharan G, Dalzell GW, et al. Biphasic energy selection for transthoracic cardioversion of atrial fibrillation. The BEST AF Trial. Heart. 2008; 94:884-7.
PubMed
CrossRef
 
Joglar JA, Hamdan MH, Ramaswamy K, Zagrodzky JD, Sheehan CJ, Nelson LL, et al. Initial energy for elective external cardioversion of persistent atrial fibrillation. Am J Cardiol. 2000; 86:348-50.
PubMed
CrossRef
 
Kawabata VS, Vianna CB, Moretti MA, Gonzalez MM, Ferreira JF, Timerman S, et al. Monophasic versus biphasic waveform shocks for atrial fibrillation cardioversion in patients with concomitant amiodarone therapy. Europace. 2007; 9:143-6.
PubMed
CrossRef
 
Kirchhof P, Eckardt L, Loh P, Weber K, Fischer RJ, Seidl KH, et al. Anterior-posterior versus anterior-lateral electrode positions for external cardioversion of atrial fibrillation: a randomised trial. Lancet. 2002; 360:1275-9.
PubMed
CrossRef
 
Kirchhof P, Mönnig G, Wasmer K, Heinecke A, Breithardt G, Eckardt L, et al. A trial of self-adhesive patch electrodes and hand-held paddle electrodes for external cardioversion of atrial fibrillation (MOBIPAPA). Eur Heart J. 2005; 26:1292-7.
PubMed
CrossRef
 
Korantzopoulos P, Kolettis TM, Papathanasiou A, Naka KK, Kolios P, Leontaridis I, et al. Propafenone added to ibutilide increases conversion rates of persistent atrial fibrillation. Heart. 2006; 92:631-4.
PubMed
CrossRef
 
Nergårdh AK, Rosenqvist M, Nordlander R, Frick M. Maintenance of sinus rhythm with metoprolol CR initiated before cardioversion and repeated cardioversion of atrial fibrillation: a randomized double-blind placebo-controlled study. Eur Heart J. 2007; 28:1351-7.
PubMed
CrossRef
 
Singh BN, Singh SN, Reda DJ, Tang XC, Lopez B, Harris CL, et al, Sotalol Amiodarone Atrial Fibrillation Efficacy Trial (SAFE-T) Investigators. Amiodarone versus sotalol for atrial fibrillation. N Engl J Med. 2005; 352:1861-72.
PubMed
CrossRef
 
Vijayalakshmi K, Whittaker VJ, Sutton A, Campbell P, Wright RA, Hall JA, et al. A randomized trial of prophylactic antiarrhythmic agents (amiodarone and sotalol) in patients with atrial fibrillation for whom direct current cardioversion is planned. Am Heart J. 2006; 151:863.
PubMed
CrossRef
 
Alatawi F, Gurevitz O, White RD, Ammash NM, Malouf JF, Bruce CJ, et al. Prospective, randomized comparison of two biphasic waveforms for the efficacy and safety of transthoracic biphasic cardioversion of atrial fibrillation. Heart Rhythm. 2005; 2:382-7.
PubMed
CrossRef
 
Alp NJ, Rahman S, Bell JA, Shahi M. Randomised comparison of antero-lateral versus antero-posterior paddle positions for DC cardioversion of persistent atrial fibrillation. Int J Cardiol. 2000; 75:211-6.
PubMed
CrossRef
 
Ambler JJ, Deakin CD. A randomized controlled trial of efficacy and ST change following use of the Welch-Allyn MRL PIC biphasic waveform versus damped sine monophasic waveform for external DC cardioversion. Resuscitation. 2006; 71:146-51.
PubMed
CrossRef
 
Boodhoo L, Mitchell AR, Bordoli G, Lloyd G, Patel N, Sulke N. DC cardioversion of persistent atrial fibrillation: a comparison of two protocols. Int J Cardiol. 2007; 114:16-21.
PubMed
CrossRef
 
Boos C, Thomas MD, Jones A, Clarke E, Wilbourne G, More RS. Higher energy monophasic DC cardioversion for persistent atrial fibrillation: is it time to start at 360 joules? Ann Noninvasive Electrocardiol. 2003; 8:121-6.
PubMed
CrossRef
 
Brazdzionyte J, Babarskiene RM, Stanaitiene G. Anterior-posterior versus anterior-lateral electrode position for biphasic cardioversion of atrial fibrillation. Medicina (Kaunas). 2006; 42:994-8.
PubMed
 
Fragakis N, Bikias A, Delithanasis I, Konstantinidou M, Liakopoulos N, Kozirakis M, et al. Acute beta-adrenoceptor blockade improves efficacy of ibutilide in conversion of atrial fibrillation with a rapid ventricular rate. Europace. 2009; 11:70-4.
PubMed
CrossRef
 
Hassan S, Slim AM, Ahmad S, Kamalakannan D, Khoury R, Kakish E, et al. Conversion of atrial fibrillation to sinus rhythm during treatment with intravenous esmolol or diltiazem: a prospective, randomized comparison. J Cardiovasc Pharmacol Ther. 2007; 12:227-31.
PubMed
CrossRef
 
Joseph AP, Ward MR. A prospective, randomized controlled trial comparing the efficacy and safety of sotalol, amiodarone, and digoxin for the reversion of new-onset atrial fibrillation. Ann Emerg Med. 2000; 36:1-9.
PubMed
CrossRef
 
Kafkas NV, Patsilinakos SP, Mertzanos GA, Papageorgiou KI, Chaveles JI, Dagadaki OK, et al. Conversion efficacy of intravenous ibutilide compared with intravenous amiodarone in patients with recent-onset atrial fibrillation and atrial flutter. Int J Cardiol. 2007; 118:321-5.
PubMed
CrossRef
 
Kanoupakis EM, Manios EG, Mavrakis HE, Tzerakis PG, Mouloudi HK, Vardas PE. Comparative effects of carvedilol and amiodarone on conversion and recurrence rates of persistent atrial fibrillation. Am J Cardiol. 2004; 94:659-62.
PubMed
CrossRef
 
Manios EG, Mavrakis HE, Kanoupakis EM, Kallergis EM, Dermitzaki DN, Kambouraki DC, et al. Effects of amiodarone and diltiazem on persistent atrial fibrillation conversion and recurrence rates: a randomized controlled study. Cardiovasc Drugs Ther. 2003; 17:31-9.
PubMed
CrossRef
 
Marinsek M, Larkin GL, Zohar P, Bervar M, Pekolj-Bicanic M, Mocnik FS, et al. Efficacy and impact of monophasic versus biphasic countershocks for transthoracic cardioversion of persistent atrial fibrillation. Am J Cardiol. 2003; 92:988-91.
PubMed
CrossRef
 
Mazzocca G, Corbucci G, Venturini E, Becuzzi L. Is pretreatment with ibutilide useful for atrial fibrillation cardioversion when combined with biphasic shock? J Cardiovasc Med (Hagerstown). 2006; 7:124-8.
PubMed
CrossRef
 
Rashba EJ, Bouhouch R, MacMurdy KA, Shorofsky SR, Peters RW, Gold MR. Effect of shock polarity on the efficacy of transthoracic atrial defibrillation. Am Heart J. 2002; 143:541-5.
PubMed
CrossRef
 
Rashba EJ, Gold MR, Crawford FA, Leman RB, Peters RW, Shorofsky SR. Efficacy of transthoracic cardioversion of atrial fibrillation using a biphasic, truncated exponential shock waveform at variable initial shock energies. Am J Cardiol. 2004; 94:1572-4.
PubMed
CrossRef
 
Redfearn DP, Skanes AC, Lane J, Stafford PJ. Signal-averaged P wave reflects change in atrial electrophysiological substrate afforded by verapamil following cardioversion from atrial fibrillation. Pacing Clin Electrophysiol. 2006; 29:1089-95.
PubMed
CrossRef
 
Scholten M, Szili-Torok T, Klootwijk P, Jordaens L. Comparison of monophasic and biphasic shocks for transthoracic cardioversion of atrial fibrillation. Heart. 2003; 89:1032-4.
PubMed
CrossRef
 
Siaplaouras S, Buob A, Rötter C, Böhm M, Jung J. Randomized comparison of anterolateral versus anteroposterior electrode position for biphasic external cardioversion of atrial fibrillation. Am Heart J. 2005; 150:150-2.
PubMed
CrossRef
 
Siaplaouras S, Buob A, Rötter C, Böhm M, Jung J. Impact of biphasic electrical cardioversion of atrial fibrillation on early recurrent atrial fibrillation and shock efficacy. J Cardiovasc Electrophysiol. 2004; 15:895-7.
PubMed
CrossRef
 
Villani GQ, Piepoli MF, Terracciano C, Capucci A. Effects of diltiazem pretreatment on direct-current cardioversion in patients with persistent atrial fibrillation: a single-blind, randomized, controlled study. Am Heart J. 2000; 140:e12.
PubMed
CrossRef
 
Chen WS, Gao BR, Chen WQ, Li ZZ, Xu ZY, Zhang YH, et al. Comparison of pharmacological and electrical cardioversion in permanent atrial fibrillation after prosthetic cardiac valve replacement: a prospective randomized trial. J Int Med Res. 2013; 41:1067-73.
PubMed
CrossRef
 
Deakin CD, Connelly S, Wharton R, Yuen HM. A comparison of rectilinear and truncated exponential biphasic waveforms in elective cardioversion of atrial fibrillation: a prospective randomized controlled trial. Resuscitation. 2013; 84:286-91.
PubMed
CrossRef
 
De Simone A, Turco P, De Matteis C, La Rocca V, Nocerino P, Greco L, et al. Effect of verapamil on secondary cardioversion in patients with early atrial fibrillation recurrence after electrical cardioversion. Am J Cardiol. 2002; 90:185-7.
PubMed
CrossRef
 
Van Noord T, Van Gelder IC, Tieleman RG, Bosker HA, Tuinenburg AE, Volkers C, et al. VERDICT: the Verapamil versus Digoxin Cardioversion Trial: a randomized study on the role of calcium lowering for maintenance of sinus rhythm after cardioversion of persistent atrial fibrillation. J Cardiovasc Electrophysiol. 2001; 12:766-9.
PubMed
CrossRef
 
Bittner A, Mönnig G, Zellerhoff S, Pott C, Köbe J, Dechering D, et al. Randomized study comparing duty-cycled bipolar and unipolar radiofrequency with point-by-point ablation in pulmonary vein isolation. Heart Rhythm. 2011; 8:1383-90.
PubMed
CrossRef
 
Blomström-Lundqvist C, Johansson B, Berglin E, Nilsson L, Jensen SM, Thelin S, et al. A randomized double-blind study of epicardial left atrial cryoablation for permanent atrial fibrillation in patients undergoing mitral valve surgery: the SWEDish Multicentre Atrial Fibrillation study (SWEDMAF). Eur Heart J. 2007; 28:2902-8.
PubMed
CrossRef
 
Boersma LV, Castella M, van Boven W, Berruezo A, Yilmaz A, Nadal M, et al. Atrial fibrillation catheter ablation versus surgical ablation treatment (FAST): a 2-center randomized clinical trial. Circulation. 2012; 125:23-30.
PubMed
CrossRef
 
Bulava A, Haniš J, Sitek D, Ošmera O, Karpianus D, Snorek M, et al. Catheter ablation for paroxysmal atrial fibrillation: a randomized comparison between multielectrode catheter and point-by-point ablation. Pacing Clin Electrophysiol. 2010; 33:1039-46.
PubMed
CrossRef
 
Calò L, Lamberti F, Loricchio ML, De Ruvo E, Colivicchi F, Bianconi L, et al. Left atrial ablation versus biatrial ablation for persistent and permanent atrial fibrillation: a prospective and randomized study. J Am Coll Cardiol. 2006; 47:2504-12.
PubMed
CrossRef
 
Chevalier P, Leizorovicz A, Maureira P, Carteaux JP, Corbineau H, Caus T, et al. Left atrial radiofrequency ablation during mitral valve surgery: a prospective randomized multicentre study (SAFIR). Arch Cardiovasc Dis. 2009; 102:769-75.
PubMed
CrossRef
 
Deisenhofer I, Estner H, Reents T, Fichtner S, Bauer A, Wu J, et al. Does electrogram guided substrate ablation add to the success of pulmonary vein isolation in patients with paroxysmal atrial fibrillation? A prospective, randomized study. J Cardiovasc Electrophysiol. 2009; 20:514-21.
PubMed
CrossRef
 
Deneke T, Khargi K, Grewe PH, Laczkovics A, von Dryander S, Lawo T, et al. Efficacy of an additional MAZE procedure using cooled-tip radiofrequency ablation in patients with chronic atrial fibrillation and mitral valve disease. A randomized, prospective trial. Eur Heart J. 2002; 23:558-66.
PubMed
CrossRef
 
Di Biase L, Elayi CS, Fahmy TS, Martin DO, Ching CK, Barrett C, et al. Atrial fibrillation ablation strategies for paroxysmal patients: randomized comparison between different techniques. Circ Arrhythm Electrophysiol. 2009; 2:113-9.
PubMed
CrossRef
 
Dixit S, Marchlinski FE, Lin D, Callans DJ, Bala R, Riley MP, et al. Randomized ablation strategies for the treatment of persistent atrial fibrillation: RASTA study. Circ Arrhythm Electrophysiol. 2012; 5:287-94.
PubMed
CrossRef
 
Dixit S, Gerstenfeld EP, Callans DJ, Cooper JM, Lin D, Russo AM, et al. Comparison of cool tip versus 8-mm tip catheter in achieving electrical isolation of pulmonary veins for long-term control of atrial fibrillation: a prospective randomized pilot study. J Cardiovasc Electrophysiol. 2006; 17:1074-9.
PubMed
CrossRef
 
Dixit S, Gerstenfeld EP, Ratcliffe SJ, Cooper JM, Russo AM, Kimmel SE, et al. Single procedure efficacy of isolating all versus arrhythmogenic pulmonary veins on long-term control of atrial fibrillation: a prospective randomized study. Heart Rhythm. 2008; 5:174-81.
PubMed
CrossRef
 
Doukas G, Samani NJ, Alexiou C, Oc M, Chin DT, Stafford PG, et al. Left atrial radiofrequency ablation during mitral valve surgery for continuous atrial fibrillation: a randomized controlled trial. JAMA. 2005; 294:2323-9.
PubMed
CrossRef
 
Elayi CS, Verma A, Di Biase L, Ching CK, Patel D, Barrett C, et al. Ablation for longstanding permanent atrial fibrillation: results from a randomized study comparing three different strategies. Heart Rhythm. 2008; 5:1658-64.
PubMed
CrossRef
 
Fiala M, Chovancík J, Nevralová R, Neuwirth R, Jiravský O, Nykl I, et al. Pulmonary vein isolation using segmental versus electroanatomical circumferential ablation for paroxysmal atrial fibrillation: over 3-year results of a prospective randomized study. J Interv Card Electrophysiol. 2008; 22:13-21.
PubMed
CrossRef
 
Khaykin Y, Skanes A, Champagne J, Themistoclakis S, Gula L, Rossillo A, et al. A randomized controlled trial of the efficacy and safety of electroanatomic circumferential pulmonary vein ablation supplemented by ablation of complex fractionated atrial electrograms versus potential-guided pulmonary vein antrum isolation guided by intracardiac ultrasound. Circ Arrhythm Electrophysiol. 2009; 2:481-7.
PubMed
CrossRef
 
Pontoppidan J, Nielsen JC, Poulsen SH, Jensen HK, Walfridsson H, Pedersen AK, et al. Prophylactic cavotricuspid isthmus block during atrial fibrillation ablation in patients without atrial flutter: a randomised controlled trial. Heart. 2009; 95:994-9.
PubMed
CrossRef
 
Roux JF, Zado E, Callans DJ, Garcia F, Lin D, Marchlinski FE, et al. Antiarrhythmics After Ablation of Atrial Fibrillation (5A Study). Circulation. 2009; 120:1036-40.
PubMed
CrossRef
 
Srivastava V, Kumar S, Javali S, Rajesh TR, Pai V, Khandekar J, et al. Efficacy of three different ablative procedures to treat atrial fibrillation in patients with valvular heart disease: a randomised trial. Heart Lung Circ. 2008; 17:232-40.
PubMed
CrossRef
 
Tamborero D, Mont L, Berruezo A, Matiello M, Benito B, Sitges M, et al. Left atrial posterior wall isolation does not improve the outcome of circumferential pulmonary vein ablation for atrial fibrillation: a prospective randomized study. Circ Arrhythm Electrophysiol. 2009; 2:35-40.
PubMed
CrossRef
 
Turco P, De Simone A, La Rocca V, Iuliano A, Capuano V, Astarita C, et al. Antiarrhythmic drug therapy after radiofrequency catheter ablation in patients with atrial fibrillation. Pacing Clin Electrophysiol. 2007; 30:Suppl 1S112-5.
PubMed
CrossRef
 
Van Breugel HN, Nieman FH, Accord RE, Van Mastrigt GA, Nijs JF, Severens JL, et al. A prospective randomized multicenter comparison on health-related quality of life: the value of add-on arrhythmia surgery in patients with paroxysmal, permanent or persistent atrial fibrillation undergoing valvular and/or coronary bypass surgery. J Cardiovasc Electrophysiol. 2010; 21:511-20.
PubMed
CrossRef
 
Verma A, Mantovan R, Macle L, De Martino G, Chen J, Morillo CA, et al. Substrate and Trigger Ablation for Reduction of Atrial Fibrillation (STAR AF): a randomized, multicentre, international trial. Eur Heart J. 2010; 31:1344-56.
PubMed
CrossRef
 
von Oppell UO, Masani N, O'Callaghan P, Wheeler R, Dimitrakakis G, Schiffelers S. Mitral valve surgery plus concomitant atrial fibrillation ablation is superior to mitral valve surgery alone with an intensive rhythm control strategy. Eur J Cardiothorac Surg. 2009; 35:641-50.
PubMed
CrossRef
 
Wang J, Meng X, Li H, Cui Y, Han J, Xu C. Prospective randomized comparison of left atrial and biatrial radiofrequency ablation in the treatment of atrial fibrillation. Eur J Cardiothorac Surg. 2009; 35:116-22.
PubMed
CrossRef
 
Willems S, Klemm H, Rostock T, Brandstrup B, Ventura R, Steven D, et al. Substrate modification combined with pulmonary vein isolation improves outcome of catheter ablation in patients with persistent atrial fibrillation: a prospective randomized comparison. Eur Heart J. 2006; 27:2871-8.
PubMed
CrossRef
 
Zhao X, Zhang J, Hu J, Liao D, Zhu Y, Mei X, et al. Pulmonary antrum radial-linear ablation for paroxysmal atrial fibrillation: interim analysis of a multicenter trial. Circ Arrhythm Electrophysiol. 2013; 6:310-7.
PubMed
CrossRef
 
Jonsson A, Lehto M, Ahn H, Hermansson U, Linde P, Ahlsson A, et al. Microwave ablation in mitral valve surgery for atrial fibrillation (MAMA). J Atr Fibrillation. 2012; 5:13-22.
 
Packer DL, Kowal RC, Wheelan KR, Irwin JM, Champagne J, Guerra PG, et al, STOP AF Cryoablation Investigators. Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American Arctic Front (STOP AF) pivotal trial. J Am Coll Cardiol. 2013; 61:1713-23.
PubMed
CrossRef
 
Fichtner S, Hessling G, Ammar S, Reents T, Estner HL, Jilek C, et al. A prospective randomized study comparing isolation of the arrhythmogenic vein versus all veins in paroxysmal atrial fibrillation. Clin Cardiol. 2013; 36:422-6.
PubMed
CrossRef
 
Abreu Filho CA, Lisboa LA, Dallan LA, Spina GS, Grinberg M, Scanavacca M, et al. Effectiveness of the maze procedure using cooled-tip radiofrequency ablation in patients with permanent atrial fibrillation and rheumatic mitral valve disease. Circulation. 2005; 112:I20-5.
PubMed
 
Akpinar B, Guden M, Sagbas E, Sanisoglu I, Ozbek U, Caynak B, et al. Combined radiofrequency modified maze and mitral valve procedure through a port access approach: early and mid-term results. Eur J Cardiothorac Surg. 2003; 24:223-30.
PubMed
CrossRef
 
Albrecht A, Kalil RA, Schuch L, Abrahão R, Sant'Anna JR, de Lima G, et al. Randomized study of surgical isolation of the pulmonary veins for correction of permanent atrial fibrillation associated with mitral valve disease. J Thorac Cardiovasc Surg. 2009; 138:454-9.
PubMed
CrossRef
 
Arentz T, Weber R, Bürkle G, Herrera C, Blum T, Stockinger J, et al. Small or large isolation areas around the pulmonary veins for the treatment of atrial fibrillation? Results from a prospective randomized study. Circulation. 2007; 115:3057-63.
PubMed
CrossRef
 
Chen M, Yang B, Chen H, Ju W, Zhang F, Tse HF, et al. Randomized comparison between pulmonary vein antral isolation versus complex fractionated electrogram ablation for paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2011; 22:973-81.
PubMed
CrossRef
 
Corrado A, Bonso A, Madalosso M, Rossillo A, Themistoclakis S, Di Biase L, et al. Impact of systematic isolation of superior vena cava in addition to pulmonary vein antrum isolation on the outcome of paroxysmal, persistent, and permanent atrial fibrillation ablation: results from a randomized study. J Cardiovasc Electrophysiol. 2010; 21:1-5.
PubMed
CrossRef
 
de Lima GG, Kalil RA, Leiria TL, Hatem DM, Kruse CL, Abrahão R, et al. Randomized study of surgery for patients with permanent atrial fibrillation as a result of mitral valve disease. Ann Thorac Surg. 2004; 77:2089-94.
PubMed
CrossRef
 
Fassini G, Riva S, Chiodelli R, Trevisi N, Berti M, Carbucicchio C, et al. Left mitral isthmus ablation associated with PV isolation: long-term results of a prospective randomized study. J Cardiovasc Electrophysiol. 2005; 16:1150-6.
PubMed
CrossRef
 
Gaita F, Caponi D, Scaglione M, Montefusco A, Corleto A, Di Monte F, et al. Long-term clinical results of 2 different ablation strategies in patients with paroxysmal and persistent atrial fibrillation. Circ Arrhythm Electrophysiol. 2008; 1:269-75.
PubMed
CrossRef
 
Gavin AR, Singleton CB, Bowyer J, McGavigan AD. Pulmonary venous isolation versus additional substrate modification as treatment for paroxysmal atrial fibrillation. J Interv Card Electrophysiol. 2012; 33:101-7.
PubMed
CrossRef
 
Jessurun ER, van Hemel NM, Defauw JJ, Brutel De La Rivière A, Stofmeel MA, Kelder JC, et al. A randomized study of combining maze surgery for atrial fibrillation with mitral valve surgery. J Cardiovasc Surg (Torino). 2003; 44:9-18.
PubMed
 
Katritsis DG, Ellenbogen KA, Panagiotakos DB, Giazitzoglou E, Karabinos I, Papadopoulos A, et al. Ablation of superior pulmonary veins compared to ablation of all four pulmonary veins:. J Cardiovasc Electrophysiol. 2004; 15:641-5.
PubMed
CrossRef
 
Kim YH, Lim HE, Pak HN, Kwak JJ, Park JS, Choi JI, et al. Role of residual potentials inside circumferential pulmonary veins ablation lines in the recurrence of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2010; 21:959-65.
PubMed
CrossRef
 
Liu X, Tan HW, Wang XH, Shi HF, Li YZ, Li F, et al. Efficacy of catheter ablation and surgical CryoMaze procedure in patients with long-lasting persistent atrial fibrillation and rheumatic heart disease: a randomized trial. Eur Heart J. 2010; 31:2633-41.
PubMed
CrossRef
 
Liu X, Long D, Dong J, Hu F, Yu R, Tang R, et al. Is circumferential pulmonary vein isolation preferable to stepwise segmental pulmonary vein isolation for patients with paroxysmal atrial fibrillation? Circ J. 2006; 70:1392-7.
PubMed
CrossRef
 
Nilsson B, Chen X, Pehrson S, Køber L, Hilden J, Svendsen JH. Recurrence of pulmonary vein conduction and atrial fibrillation after pulmonary vein isolation for atrial fibrillation: a randomized trial of the ostial versus the extraostial ablation strategy. Am Heart J. 2006; 152:537.e1-8.
PubMed
CrossRef
 
Oral H, Chugh A, Good E, Igic P, Elmouchi D, Tschopp DR, et al. Randomized comparison of encircling and nonencircling left atrial ablation for chronic atrial fibrillation. Heart Rhythm. 2005; 2:1165-72.
PubMed
CrossRef
 
Oral H, Chugh A, Lemola K, Cheung P, Hall B, Good E, et al. Noninducibility of atrial fibrillation as an end point of left atrial circumferential ablation for paroxysmal atrial fibrillation: a randomized study. Circulation. 2004; 110:2797-801.
PubMed
CrossRef
 
Pires LM, Leiria TL, de Lima GG, Kruse ML, Nesralla IA, Kalil RA. Comparison of surgical cut and sew versus radiofrequency pulmonary veins isolation for chronic permanent atrial fibrillation: a randomized study. Pacing Clin Electrophysiol. 2010; 33:1249-57.
PubMed
CrossRef
 
Schuetz A, Schulze CJ, Sarvanakis KK, Mair H, Plazer H, Kilger E, et al. Surgical treatment of permanent atrial fibrillation using microwave energy ablation: a prospective randomized clinical trial. Eur J Cardiothorac Surg. 2003; 24:475-80.
PubMed
CrossRef
 
Sheikh I, Krum D, Cooley R, Dhala A, Blanck Z, Bhatia A, et al. Pulmonary vein isolation and linear lesions in atrial fibrillation ablation. J Interv Card Electrophysiol. 2006; 17:103-9.
PubMed
CrossRef
 
Wazni O, Marrouche NF, Martin DO, Gillinov AM, Saliba W, Saad E, et al. Randomized study comparing combined pulmonary vein-left atrial junction disconnection and cavotricuspid isthmus ablation versus pulmonary vein-left atrial junction disconnection alone in patients presenting with typical atrial flutter and atrial fibrillation. Circulation. 2003; 108:2479-83.
PubMed
CrossRef
 
Knaut M, Kolberg S, Brose S, Jung F. Epicardial microwave ablation of permanent atrial fibrillation during a coronary bypass and/or aortic valve operation: prospective, randomised, controlled, mono-centric study. Appl Cardiopulm Pathophysiol. 2010; 14:220-8.
 
Karch MR, Zrenner B, Deisenhofer I, Schreieck J, Ndrepepa G, Dong J, et al. Freedom from atrial tachyarrhythmias after catheter ablation of atrial fibrillation: a randomized comparison between 2 current ablation strategies. Circulation. 2005; 111:2875-80.
PubMed
CrossRef
 
Oral H, Chugh A, Yoshida K, Sarrazin JF, Kuhne M, Crawford T, et al. A randomized assessment of the incremental role of ablation of complex fractionated atrial electrograms after antral pulmonary vein isolation for long-lasting persistent atrial fibrillation. J Am Coll Cardiol. 2009; 53:782-9.
PubMed
CrossRef
 
Oral H, Chugh A, Good E, Crawford T, Sarrazin JF, Kuhne M, et al. Randomized evaluation of right atrial ablation after left atrial ablation of complex fractionated atrial electrograms for long-lasting persistent atrial fibrillation. Circ Arrhythm Electrophysiol. 2008; 1:6-13.
PubMed
CrossRef
 
Mun HS, Joung B, Shim J, Hwang HJ, Kim JY, Lee MH, et al. Does additional linear ablation after circumferential pulmonary vein isolation improve clinical outcome in patients with paroxysmal atrial fibrillation? Prospective randomised study. Heart. 2012; 98:480-4.
PubMed
CrossRef
 
Sawhney N, Anousheh R, Chen W, Feld GK. Circumferential pulmonary vein ablation with additional linear ablation results in an increased incidence of left atrial flutter compared with segmental pulmonary vein isolation as an initial approach to ablation of paroxysmal atrial fibrillation. Circ Arrhythm Electrophysiol. 2010; 3:243-8.
PubMed
CrossRef
 
Hocini M, Jaïs P, Sanders P, Takahashi Y, Rotter M, Rostock T, et al. Techniques, evaluation, and consequences of linear block at the left atrial roof in paroxysmal atrial fibrillation: a prospective randomized study. Circulation. 2005; 112:3688-96.
PubMed
CrossRef
 
Haïssaguerre M, Sanders P, Hocini M, Hsu LF, Shah DC, Scavée C, et al. Changes in atrial fibrillation cycle length and inducibility during catheter ablation and their relation to outcome. Circulation. 2004; 109:3007-13.
PubMed
CrossRef
 
Wang XH, Liu X, Sun YM, Shi HF, Zhou L, Gu JN. Pulmonary vein isolation combined with superior vena cava isolation for atrial fibrillation ablation: a prospective randomized study. Europace. 2008; 10:600-5.
PubMed
CrossRef
 
Wang YL, Liu X, Tan HW, Zhou L, Jiang WF, Gu J, et al. Evaluation of linear lesions in the left and right atrium in ablation of long-standing atrial fibrillation. Pacing Clin Electrophysiol. 2013; 36:1202-10.
PubMed
CrossRef
 
Bogun F, Bender B, Li YG, Hohnloser SH. Ablation of atypical atrial flutter guided by the use of concealed entrainment in patients without prior cardiac surgery. J Cardiovasc Electrophysiol. 2000; 11:136-45.
PubMed
CrossRef
 
Katritsis DG, Panagiotakos DB, Karvouni E, Giazitzoglou E, Korovesis S, Paxinos G, et al. Comparison of effectiveness of carvedilol versus bisoprolol for maintenance of sinus rhythm after cardioversion of persistent atrial fibrillation. Am J Cardiol. 2003; 92:1116-9.
PubMed
CrossRef
 
Le Heuzey JY, De Ferrari GM, Radzik D, Santini M, Zhu J, Davy JM. A short-term, randomized, double-blind, parallel-group study to evaluate the efficacy and safety of dronedarone versus amiodarone in patients with persistent atrial fibrillation: the DIONYSOS study. J Cardiovasc Electrophysiol. 2010; 21:597-605.
PubMed
CrossRef
 
Roy D, Talajic M, Dorian P, Connolly S, Eisenberg MJ, Green M, et al. Amiodarone to prevent recurrence of atrial fibrillation. Canadian Trial of Atrial Fibrillation Investigators. N Engl J Med. 2000; 342:913-20.
PubMed
CrossRef
 
AFFIRM First Antiarrhythmic Drug Substudy Investigators. Maintenance of sinus rhythm in patients with atrial fibrillation: an AFFIRM substudy of the first antiarrhythmic drug. J Am Coll Cardiol. 2003; 42:20-9.
PubMed
CrossRef
 
Bellandi F, Simonetti I, Leoncini M, Frascarelli F, Giovannini T, Maioli M, et al. Long-term efficacy and safety of propafenone and sotalol for the maintenance of sinus rhythm after conversion of recurrent symptomatic atrial fibrillation. Am J Cardiol. 2001; 88:640-5.
PubMed
CrossRef
 
De Simone A, De Pasquale M, De Matteis C, Canciello M, Manzo M, Sabino L, et al. VErapamil plus antiarrhythmic drugs reduce atrial fibrillation recurrences after an electrical cardioversion (VEPARAF Study). Eur Heart J. 2003; 24:1425-9.
PubMed
CrossRef
 
Kochiadakis GE, Igoumenidis NE, Hamilos ME, Tzerakis PG, Klapsinos NC, Chlouverakis GI, et al. Sotalol versus propafenone for long-term maintenance of normal sinus rhythm in patients with recurrent symptomatic atrial fibrillation. Am J Cardiol. 2004; 94:1563-6.
PubMed
CrossRef
 
Kochiadakis GE, Igoumenidis NE, Hamilos MI, Tzerakis PG, Klapsinos NC, Zacharis EA, et al. Long-term maintenance of normal sinus rhythm in patients with current symptomatic atrial fibrillation: amiodarone vs propafenone, both in low doses. Chest. 2004; 125:377-83.
PubMed
CrossRef
 
Kochiadakis GE, Igoumenidis NE, Marketou ME, Kaleboubas MD, Simantirakis EN, Vardas PE. Low dose amiodarone and sotalol in the treatment of recurrent, symptomatic atrial fibrillation: a comparative, placebo controlled study. Heart. 2000; 84:251-7.
PubMed
CrossRef
 
Kochiadakis GE, Marketou ME, Igoumenidis NE, Chrysostomakis SI, Mavrakis HE, Kaleboubas MD, et al. Amiodarone, sotalol, or propafenone in atrial fibrillation: which is preferred to maintain normal sinus rhythm? Pacing Clin Electrophysiol. 2000; 23:1883-7.
PubMed
CrossRef
 
Plewan A, Lehmann G, Ndrepepa G, Schreieck J, Alt EU, Schömig A, et al. Maintenance of sinus rhythm after electrical cardioversion of persistent atrial fibrillation; sotalol vs bisoprolol. Eur Heart J. 2001; 22:1504-10.
PubMed
CrossRef
 
Bertaglia E, D'Este D, Zerbo F, Zoppo F, Delise P, Pascotto P. Success of serial external electrical cardioversion of persistent atrial fibrillation in maintaining sinus rhythm; a randomized study. Eur Heart J. 2002; 23:1522-8.
PubMed
CrossRef
 
Ionescu-Ittu R, Abrahamowicz M, Jackevicius CA, Essebag V, Eisenberg MJ, Wynant W, et al. Comparative effectiveness of rhythm control vs rate control drug treatment effect on mortality in patients with atrial fibrillation. Arch Intern Med. 2012; 172:997-1004.
PubMed
CrossRef
 
Cosedis Nielsen J, Johannessen A, Raatikainen P, Hindricks G, Walfridsson H, Kongstad O, et al. Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation. N Engl J Med. 2012; 367:1587-95.
PubMed
CrossRef
 

Letters

CME Activities are only available to ACP members and Individual Annals subscribers. If you are a member or a subscriber please sign in. Otherwise please become a member or subscribe to Annals.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments