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Recent studies have indicated that outcomes in patients with atrial fibrillation who are managed with rate control and anticoagulation are similar to those in patients who have maintenance of sinus rhythm. These studies did not include important groups of pa-tients with atrial fibrillation in whom antiarrhythmic therapy may be appropriate. This perspective argues for the maintenance of sinus rhythm and for the use of antiarrhythmic therapy that in-cludes medications, invasive procedures, and a combination of both in appropriate patients