creators_name: L, Testa creators_name: G, Trotta creators_name: A, Dello Russo creators_name: M, Casella creators_name: G, Pelargonio creators_name: F, Andreotti creators_name: F, Bellocci editors_name: Singh, Balbir editors_name: Lokhandwala, Yash editors_name: Francis, Johnson editors_name: Gupta, Anup type: journalp datestamp: 2005-11-12 lastmod: 2011-03-11 08:56:13 metadata_visibility: show title: Rate-Control or Rhythm-Contol: Where do we stand? ispublished: pub subjects: ipej full_text_status: public keywords: atrial fibrillation, rate control, rhythm control, secondary prevention abstract: Atrial fibrillation is the most common sustained rhythm disturbance and its prevalence is increasing worldwide due to the progressive aging of the population. Current guidelines clearly depict the gold standard management of acute symptomatic atrial fibrillation but the best-long term approach for first or recurrent atrial fibrillation is still debated with regard to quality of life, risk of new hospitalizations, and possible disabling complications, such as thromboembolic stroke, major bleeds and death. Some authors propose that regaining sinus rhythm in all cases, thus re-establishing a physiologic cardiac function not requiring a prolonged antithrombotic therapy, avoids the threat of intracranial or extracranial haemorrhages due to Vitamin K antagonists or aspirin. On the contrary, advocates of a rate control approach with an accurate antithrombotic prophylaxis propose that such a strategy may avoid the risk of cardiovascular and non cardiovascular side effects related to antiarrhythmic drugs. 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