Abstract: . . .  Intervention in Atrial Fibrillation (PIAF): a randomised trial. Lancet 2000; 356: 1789-1794. 3. Wyse DG, Waldo AL, DiMarco JP, et al for the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) investigators. A comparison of rate control and rhythm control in patients with atrial fibrillation . N Engl J Med 2002; 347: 1825-1833. 4. Van Gelder IC, Hagens VE, Bosker HA, et al. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation . N Engl J Med 2002; 347: 1834-1840. 5. Laupacis A, Boysen G, Connolly S, et al. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation : analysis of pooled data from five ran- domized controlled trials. Arch Intern Med 1994; 154: 1449-1457. 6. Page RL, Wilkinson WE, Clair WK, et al. Asymptomatic arrhythmias in patients with symptomatic paroxysmal atrial fibrillation and paroxysmal supraventricular tachycar- dia. Circulation 1994; 89: 224-227. 7. Lamas GA, Lee KL, Sweeney MO, et al. Ventricular pacing or dual-chamber pacing for sinus-node dysfunction. N Engl J Med 2002; 346: 1854-1862. 8. Hassaguerre M, Fischer B, Labbe T, et al. Frequency of recurrent atrial fibrillation . . .
. . .  management of AF. They concentrated on older, high-risk patients, excluding or under-representing some subgroups of patients who experience AF, for example: patients considered unsuitable for one of the strategies (eg, those with hypertrophic cardiomyopathy, those too sympto- matic in rate-controlled AF, or those at unacceptably high risk of bleeding with anticoagulation); and patients under 65 years of age and with no other risk factors for stroke or death. Managing atrial fibrillation redrawing a line in the sand Page 2 MJA Vol 178 19 May 2003 481 EDITORIALS For many such patients, and for most patients first episode of persistent AF, it remains appropriate to cardiovert once, with a level of anticoagulation appropriate to the patients risk benefit profile for some weeks or months, meanwhile treating any concomitant predisposing conditions (congestive heart failure, lung disease, etc), and then review. Many issues need to be considered when deciding and revising optimal treatment in an individual patient. In selected individuals, potentially curative non-pharmacological treatments (eg, pacing, 7  . . .
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