A New Beat on an Old Rhythm

Abstract

* Age. More than 84% of people with AF are over age 65 (with a roughly equal incidence among men and women). * Mortality. Findings from several epidemiologic studies have shown increased morbidity and mortality.'-5 Most notably, 1998 data from the Framingham Heart Study indicate that AF is independently associated with a substantially increased risk for death (1.5-fold for men and 1.9-fold for women), even after adjustment for age and associated factors such as hypertension, congestive heart failure, and stroke. * Cost. In 1998, the estimated increase in cost of treating AF and its sequelae (thromboembolic stroke and heart failure) for patients over age 75 was $2,500 for men and $1,700 for women.6 * Sequelae. Findings from randomized clinical trials have demonstrated that anticoagulants markedly reduce the risk of thromboembolic stroke, one of AF's major sequelae.--12 Treatment options have broadened during the past decade as well, owing in part to recent data on the electrophysiologic mechanisms underlying AE'26 The two standard treatments-restoration and maintenance of normal sinus rhythm (NSR), and ventricular rate control-can involve both electrical and pharmacologic means. Many innovative therapies have shown success-radiofrequency catheter ablation, cardiac pacing, internal atrial defibrillation, and surgery-though the debate continues over whether maintenance of sinus rhythm (rhythm control) or ventricular rate control provides better long-term results. Researchers hope to