The Increasing Role of Rhythm Control in Patients With Atrial Fibrillation: JACC State-of-the-Art Review

J Am Coll Cardiol. 2022 May 17;79(19):1932-1948. doi: 10.1016/j.jacc.2022.03.337.


The considerable mortality and morbidity associated with atrial fibrillation (AF) pose a substantial burden on patients and health care services. Although the management of AF historically focused on decreasing AF recurrence, it evolved over time in favor of rate control. Recently, more emphasis has been placed on reducing adverse cardiovascular outcomes using rhythm control, generally by using safe and effective rhythm-control therapies (typically antiarrhythmic drugs and/or AF ablation). Evidence increasingly supports early rhythm control in patients with AF that has not become long-standing, but current clinical practice and guidelines do not yet fully reflect this change. Early rhythm control may effectively reduce irreversible atrial remodeling and prevent AF-related deaths, heart failure, and strokes in high-risk patients. It has the potential to halt progression and potentially save patients from years of symptomatic AF; therefore, it should be offered more widely.

Keywords: antiarrhythmic drugs; atrial fibrillation progression; catheter ablation; early intervention; new-onset atrial fibrillation; paroxysmal atrial fibrillation.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Arrhythmia Agents / therapeutic use
  • Atrial Fibrillation* / drug therapy
  • Atrial Fibrillation* / therapy
  • Atrial Remodeling*
  • Catheter Ablation* / adverse effects
  • Humans
  • Stroke* / etiology
  • Stroke* / prevention & control
  • Stroke* / surgery
  • Treatment Outcome


  • Anti-Arrhythmia Agents