Introduction
The Atrial fibrillation Better Care (ABC) pathway for holistic
management of atrial fibrillation (AF) is based on simple approach (A,
Avoid stroke, B, Better symptom management, C, Cardiovascular and
comorbidity risk reduction) [1]. One of the components of this
pathway for integrated care management is better symptom management with
the use of rate or rhythm control. Such a management strategy based on
symptoms enables to hierarchize the initial management strategy, with
the decision being patient-centred [1].
Rate control is the strategy that tend to be usually adequate to improve
symptoms related with AF [2]. The evidence for the optimal type and
intensity of rate control strategy are scarce [3-5]. The aim of a
rhythm control strategy is to reduce AF-related symptoms by maintaining
sinus rhythm and reducing the recurrence of AF. The use of
antiarrhythmic agents allows the maintenance of sinus rhythm, which is
approximately two times greater compared with placebo [6-8]. When
antiarrhythmic drugs are ineffective, catheter ablation or combination
therapy may be chosen [9-11].
Both rate and rhythm strategy tend to be non-inferior in case of
mortality, stroke and hospitalization [3, 7, 12-16]. Some studies
showed contradictory results with lower mortality in patients on rhythm
control strategy when compared to rate control [17-19].
The BALKAN-AF was a registry conducted in seven countries (Albania,
Bosnia & Herzegovina, Bulgaria, Croatia, Montenegro, Romania and
Serbia) in the Balkan region, to find out contemporary management of AF
patients in the region encompassing approximately 50 million
inhabitants. Moreover, data regarding this region in large,
international AF registries are scarce [20].
The aim of this study was to (i) evaluate the use of rhythm control and
rate control strategy and (ii) identify predictors of the use of
amiodarone in patients with rhythm control and of the use of rhythm
control strategy in patients with paroxysmal AF in seven Balkan
countries.