[Drug therapy of atrial fibrillation: control of heart rate versus establishing sinus rhythm].

Our knowledge about efficacy and safety of various therapeutic strategies is insufficient, especially with respect to the direct comparison of reestablishment of sinus rhythm by drugs in comparison to rate control. Therefore, an initiative of the German Working Group on Electrophysiology of the Deutsche Gesellschaft für Kardiologie--Herz- und Kreislaufforschung is urgently needed which will compare these strategies in a prospective controlled trial (pharmacologic intervention in atrial fibrillation PIAF: Reestablishment of sinus rhythm by the drug amiodarone, in addition DC-defibrillation if necessary; rate control with the calcium antagonist diltiazem). It is hoped that this study will give quantitative data about recurrences of arrhythmia, quality of life and exercise capacity. A much bigger study, presumably including 5300 patients, will be performed in the USA supported by the National Institute of Health (AFFIRM study: atrial fibrillation follow-up: investigation of rhythm management) which will assess the consequences of cardioversion and rate control of atrial fibrillation, not only on morbidity, but also on mortality. Until these study results are available, the physician will have to make his individual choice based on the preferences of the patient, a cost-benefit analysis, current data and experience.