ABSTRACT
Atrial fibrillation (AF) is a very common cardiac arrhythmia associated with a number of clinical outcomes, including death, thromboembolism (primarily stroke), congestive heart failure (CHF), and other morbidity; it also causes symptoms. However, association between AF and these consequences does not prove that AF is the cause of these problems. Much of the research about rhythm management for AF during the last two decades has ignored or forgotten this principle. An apparently widely held view was that when AF is abolished, the problems associated with it are also abolished. Accordingly, many studies of therapy for AF have used maintenance of sinus rhythm itself as their endpoint. Such research ignores the possibility-indeed, the probability-that the morbidity associated with AF is at least partly caused by the disease process that is the background for AF, not the AF itself.
