Optimizing the treatment of atrial fibrillation: contributions by remote monitoring

Abstract

Despite more than a decade of intensified clinical research, our knowledge about atrial fibrillation (AF) is still far from satisfactory, and particularly the optimal treatment remains unclear. In fact, even the very basic question if attempts should be made to convert AF into sinus rhythm and to maintain it, or to simply limit the ventricular rate by drugs that slow atrioventricular conduction (and which strategy in whom?) is not yet answered satisfactory. Results of the AFFIRM1 and AF-CHF2 trials were disappointing to a high degree showing no advantage of trying to maintain sinus rhythm or even a trend towards a higher mortality for ‘rhythm control’. This leads to the misinterpretation that AF seems to be harmless even in the context of heart failure. To avoid this, it should be pointed out that a post hoc analysis of the AFFIRM trial demonstrated that patients who were in sinus rhythm (no matter to which treatment group they were allocated) had a better … *Corresponding author. Tel: +49 69 6301 7387; fax: +49 69 6301 3813, E-mail address : C.W.Israel{at}em.uni-frankfurt.de