Strategia utrzymania rytmu zatokowego u pacjentów z niezastawkowym migotaniem przedsionków — stan wiedzy, kontrowersje, toczące się badania

The main therapeutic problem in patients with atrial fibrillation (AF), besides determining indications for anticoagulant therapy, is the choice of rhythm control strategy vs rate control strategy. The 2016 guidelines recommend choosing rhythm control strategy “only” in order to reduce the symptoms resulting from arrhythmia. Previous studies comparing these treatment strategies in patients with AF did not reveal the advantage of one strategy over the other. In multicenter studies, such as AFFIRM, RACE, STAFF, PIAF, HOT CAFE, there were no differences between both strategies in terms of mortality and cardiovascular morbidity, although many post-hoc analyzes showed evidence of superiority of rhythm control strategies, taking into account so called soft endpoints, such as improving physical performance or humoral profile. Although current guidelines recommend a paradigm of maintaining sinus rhythm “only” to improve patients’ symptoms, observational studies show that patients with restored and maintained sinus rhythm are characterized by a better prognosis. The article presents the current state of knowledge regarding the choice of treatment strategy in patients with non-valvular AF.