Rhythm-control Strategy

In patients in whom the onset of AF is <48 hours, the option exists to attempt to restore sinus rhythm whilst the patient is in the ED.

Rhythm control produces the same benefits through the same mechanisms as rate control but also restores atrial transport. Furthermore, the maintenance of sinus rhythm has been thought to reduce the problems of atrial re-modelling. 12

All patients who are being considered for a rhythm control strategy should be offered anticoagulation with treatment dose LMWH (unless contraindications exist) until a full assessment has been made and further anticoagulation started. However, This should not delay emergency DCCV in the haemodynmically unstable patient. 1