Atrial fibrillation--maintaining sinus rhythm versus ventricular rate control: the PIAF trial. Pharmacological Intervention in Atrial Fibrillation.

INTRODUCTION: In patients with persistent atrial fibrillation, therapy can be directed toward restoration of sinus rhythm or control of ventricular rate only. There are no prospective data in the literature comparing both treatment strategies.

METHODS AND RESULTS: Patients with symptomatic persistent atrial fibrillation (duration > or = 7 and < or = 360 days) will be randomized to control of ventricular rate only or to conversion therapy. All patients will be followed for 12 months. Diltiazem is used as the primary therapy for rate control, whereas amiodarone will be administered for restoration and maintenance of sinus rhythm. The primary endpoint of the trial is the recurrence of symptomatic tachyarrhythmic episodes in patients randomized to rate control and recurrent atrial fibrillation in the alternative treatment arm. A number of secondary endpoints also will be investigated. The trial is expected to end its follow-up in the summer of 1998.

CONCLUSION: PIAF (Pharmacological Intervention in Atrial Fibrillation) is one of several trials designed to evaluate the optimal treatment strategy in patients with persistent atrial fibrillation. The results hopefully will help to improve care of patients with this common rhythm disorder.