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A trial fibrillation (AF) is the most common arrhythmia in daily clinical practice and is strongly related to the high occurrence of cerebral infarction as well as heart failure. Firstly, we provide optimal anticoagulation and pharmacological rate control strategy to AF patients. However, we also consider whether we should defibrillate AF and we maintain sinus rhythm using a pharmacological approach as well as invasive strategy. Nowadays, catheter ablation including conventional radiofrequency ablation, cryoballoon ablation and other novel modalities are often used around the world for symptomatic patients with paroxysmal or persistent AF and the success rate and AF-free survival have been improved and are now acceptable. Of note, a recent important paper showed that AF ablation also improves the survival of patients with heart failure complicated with AF. AF is caused and maintained by multiple factors including electrical and anatomical remodeling under pressure/volume overload, autonomic dysregulation, and various stresses. When AF persists, atrial electrical and anatomical remodeling progress leading to not only maintenance of AF but also sinus node dysfunction related to atrial fibrosis in the surrounding area of the sinus node and a decrease in the number of sinus nodal cells. Theoretically, sinus node dysfunction is thought to be associated with AF persistence and resistance to rhythm control strategy, however, there have been very few reports on this important issue.

Sinus Node Recovery Time Can Predict Maintenance of Sinus Rhythm After Catheter Ablation for Long-Standing Atrial Fibrillation