NEWS & VIEWS ATRIAL FIBRILLATION
This reduction reflects the findings from studies that demonstrate the noninferiority of a rate-control strategy compared with a rhythm-control strategy with antiarrhythmic drugs, and the increased application of a catheter-ablation strategy for AF.1,2 Overall, a rhythm-control strategy remained uncommon in individuals with AF, with electrical and pharmacological cardiov ersion in 10% and 5% of patients, respectively. Catheter ablation, an established treatment option for patients with symptomatic, drugrefractory AF, was performed in only 4% of patients, which reflects the selective status of this emerging and promising therapy option. The results of ongoing multicentre trials might lead to an increase in the use of AF ablation in coming years. As for symptoms and outcome, in this 1‑year follow-up analysis of the EORP-AF Pilot registry, patients were frequently asymptomatic (77%), but symptoms were still common among those with persistent AF, especially palpitations (66%), fatigue (48%), and shortness of breath (46%). Mortality at 1 year was high (6%), 70% of which were cardiovascular deaths, and hospital readmissions were common and often owing to AF or heart failure—a finding similar to those reported by other investigators.9 Patients
AF prognosis and treatment —the European perspective Daniel Scherr and Pierre Jais
In the EORP-AF Pilot registry on the prognosis and treatment of patients with atrial fibrillation (AF), 1‑year mortality is high. Symptoms are still common in patients with AF, and hospital readmissions are mainly owing to AF and heart failure. Oral anticoagulation use has increased, but a rhythm-control strategy is uncommon.
Given the advances in atrial fibrillation (AF) management, such as the availability of novel oral anticoagulants (NOACs), new antiarrhythmic drugs, and advances in catheter ablation, systematic collection of data regarding the management and treatment of AF is needed. In a new paper, Lip et al. report on the prevalence of AF symptoms, use of antithrombotic therapy, rate-control versus rhythm-control strategies, as well as determinants of mortality and morbidity in the contemporary EORP-AF Pilot registry, which included 3,119 patients with AF from nine European countries.1 These data were compared with European Heart Study data from 2003, which were collected using the same study design.2 AF is the most common cardiac arrhythmia, and associated with an increased risk of stroke, heart failure, dementia, as well as cardiovascular and all-cause mortality. Some predictions estimate that between 2010 and 2060, the number of adults aged ≥55 years with AF in the European Union will more than double.3 New guidelines on the management of AF have been published by the ESC,4,5 but to what extent clinicians adhere to them is still unclear. Stroke prevention remains the major challenge in the treatment of patients with AF. When comparing the results of the Euro Heart Survey with those of the EORP-AF Pilot registry, one can conclude that the use of anticoagulation has increased in Europe over the past decade, with >80% of patients with AF at risk of embolism receiving appropriate anticoagulants.1,2 Therapy persistence over the course of 1 year is 84% for vitamin K antagonist therapy and 86% for NOAC
therapy. However, the use of NOACs was still low, with