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.