Rate Control Is Local Better?

The control of ventricular rate plays an important role inthe management of patients with atrial fibrillation,decreasing symptoms and improving cardiac function, exercise capacity, and quality of life.1–3 Oral or intravenous agents are routinely administered to achieve adequate control of the ventricular rate by modulating atrioventricular nodal function. The systemic effects of calcium channel antagonists and -adrenergic receptor antagonists on blood pressure and other adverse effects, however, may limit use of these agents in some patients. In other patients, it may be difficult to achieve adequate rate control with the use of pharmacological agents. Article p 2383 In their article in this issue of Circulation, Sigg et al4 describe the novel approach of delivering pharmacological agents via a luminal catheter secured to the region of the atrioventricular node. Using a steerable electrophysiologica