Evidence for atrial fibrillation (AF) therapies

Rate control is non-inferior to rhythm control and may be superior in elderly or co-morbid patients (AFFIRM). Strict rate control may provide no further benefits (RACE-II)

Anticoagulation is beneficial even in rhythm control (AFFIRM). Aspirin is sufficient in low-risk patients (SPAF), but anti-thrombotic agents are necessary in high risk patients (SPAF-II). Newer agents such as apixiban (ARISTOTLE), rivaroxaban (ROCKET-AF) and dabigatran (RE-LY) may reduce stroke and/or bleeding

Dronedarone may be beneficial in low-risk paroxysmal or persistant AF patients (ATHENA) but appears harmful in higher risk patients (PALLAS)

Ablation appears successful in those failing rhythm control (APAF, ThermoCool-AF) but is not successful as a first-line treatment (MANTRA-PAF)

Topic Therapy group Therapy Trial
Atrial Fibrillation Ablation Paroxysmal AF APAF, ThermoCool-AF
RFA (treatment naive) MANTRA-PAF
Anticoagulation Apixiban ARISTOTLE
Dabigatran RE-LY
Rivaroxaban ROCKET-AF
Rate & Rhythm control Dronedarone ATHENA, PALLAS
Lenient vs strict rate control RACE-II
Rate vs. rhythm control AFFIRM