Rhythm control strategies for symptomatic atrial fibrillation

Atrial fibrillation is a major health problem. It is the most common sustained cardiac arrhythmia and the prevalence of atrial fibrillation continues to rise in Western nations. In The Netherlands life time risk of atrial fibrillation is roughly 1 in 4 for persons >40 years old, and the currently estimated prevalence of atrial fibrillation 300,000 persons. The majority of patients have atrial fibrillation in association with underlying cardiovascular disease. Atrial fibrillation causes symptoms such as palpitations, angina, dyspnea, impaired exercise tolerance, anxiety and fatigue, ranging from mild discomfort to severe complications with a negative impact on quality of life. The two mainstay therapeutic approaches are rate control, involving acceptance of the arrhythmia and the institution of ventricular rate control, and rhythm control, aiming at the restoration and maintenance of sinus rhythm. The general consensus is that the two strategies are essentially equivalent with respect to the risk-benefit ratio for the majority of patients with persistent atrial fibrillation. In severely symptomatic patients, however, still rhythm control is first choice therapy. Rhythm control must be improved for those patients who benefit from sinus rhythm. In this thesis we evaluated both pharmacological and non-pharmacological rhythm control strategies aiming to contribute to the development of an optimal rhythm control strategy.

	Part I : Pharmacological rhytm control
	Part II: Non-pharmacological rhythm control
	Part III: Discussion and future perspectives

	Title and contents
	General introduction
	Dankwoord
	Bibliography
	Complete thesis

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