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Several recent randomized clinical trials comparing strategies based on control of ventricular rate versus those based on maintenance of sinus rhythm in elderly or high risk patients with atrial fibrillation have recently been reported.1,2⇓ Preliminary data from these trials suggest that the 2 strategies can produce roughly equivalent clinical outcomes. For individual patients, either approach may be appropriate because there appears to be no inherent advantage to a rhythm control strategy. These studies should cause doctors to look again at our techniques for achieving rate control in atrial fibrillation.See p 1853 Pharmacological therapy has long been the primary technique for controlling ventricular rates in patients with atrial fibrillation. Cardiac glycosides, β-adrenergic blockers, or calcium channels blockers are used, alone or frequently in combination, to prolong atrioventricular (AV) nodal refractoriness. Increased concealed conduction in the AV node results in moderation of the ventricular rate with conduction now occurring in an irregularly, …

Selective Vagal Stimulation for Rate Control in Atrial Fibrillation