W Heddle Flinders University of South Australia
    Atrial fibrillation (AF) is the commonest arrhythmia resulting in hospitalisation in Australia.  Unlike some other areas of cardiology such as management of acute coronary syndromes， there is a relative paucity of randomised clinical trials （RCTs） informing management of AF. The management varies widely across countries and between hospitals， even in the same city; in part this reflects relative paucity of evidence base for treatment.
    The results from the RECORDAF Registry published in JACC in this issue added important information to AF management. These observations reflect “real-life” clinical practice as against the strictly defined populations studied in RCTs. As the authors discuss， registries also have limitations， particularly in comparison of treatment strategies， as (well defined in this registry) the populations selected for different treatments show substantial baseline differences.
Important points from the RECORDAF registry include:
    1) Adverse clinical outcomes were seen with underlying morbidity such as renal disease， coronary artery disease， heart failure， and stroke
    2) Symptoms predicted adverse outcomes independent of associated disease
    3) Short duration of AF (< 3 months) was associated with worse outcomes (consistent with prior studies)
    4) Physicians prefer rhythm control to rate control strategy
    5) Patients selected for rhythm control were more likely to be in sinus rhythm at 12 months
    6) No substantial differences in outcome seen in “Athena study” like patients whether a rate or rhythm control strategy was adopted
    7) In patients selected for rate control strategy， 54% were in permanent AF at one year (vs. 13% in rhythm control strategy)
    8) Only 59% of patients with CHADS2 score > = 2 were treated with a vitamin K antagonist
    9) Hospitalisation occurred in 17% of patients in both rate and rhythm control strategies
  10) The choice of rate or rhythm control strategy did not appear to influence the clinical outcome
    In summary this study confirms the importance of risk factors in outcome， and supports physician preference for rhythm control strategy in patients with symptomatic AF. However， in my opinion， yet more information from RCTs and further registry data are needed to further define the optimal treatment strategies in AF.
摘要
    AF是最常见的心律失常，关于AF管理的随机临床试验仍然欠缺，导致AF临床治疗存在明显变异。本期JACC发表的RECORDAF研究结果为AF管理增添了信息，但仍有其局限性，特别是不同策略组的患者基线特征存在明显差异。
    RECORDAF研究的主要发现包括：不良结局主要发生于存在肾病、冠心病、心力衰竭、卒中等潜在合并症的患者；症状可预测不良结局，独立于相关疾病；较短的AF病程（< 3 个月）与结局更差相关；相对于频率控制，医生更倾向于选择节律控制；接受节律控制的患者12个月时更多维持于窦性节律；频率控制组54%的患者1年时处于永久性AF，而节律控制组为13%；仅59%的CHADS2积分≥2的患者接受了抗凝治疗；两种策略住院率及临床结局无差异。
    该研究再次肯定了危险因素对结局的重要影响，支持对症状性AF患者优先选择节律控制策略。但仍需更多的RCTs和注册研究数据进一步明确AF的最佳治疗策略。