Can ablation prevent the excess mortality of atrial fibrillation?

The relative merits of rate and rhythm control in the treatment of patients with atrial fibrillation have been compared in several major clinical trials, none of which demonstrated a significant difference in all-cause mortality. Yet, there is clear evidence that restoration and maintenance of sinus rhythm is associated with beneficial reverse atrial remodeling. These apparently contradictory findings may reflect the combination of serious adverse effects coupled with limited efficacy of currently available antiarrhythmic drugs, counterbalancing their beneficial effect in restoring sinus rhythm. Catheter ablation offers an alternative means of restoring sinus rhythm in patients with atrial fibrillation, and several clinical trials have indicated its superior outcomes and improved benefit/risk profile. Ongoing trials will soon determine its overall impact on survival.