The two major problems of rhythmology in the year 2000 were mainly therapeutic : on the one hand, the treatment of atrial fibrillation and, on the other hand, the treatment of sudden arrhythmic death. These two subjects should not mask the fermentation of ideas, techniques, and diagnostic and therapeutic suggestions which have made up one year of scientific literature in this field. However, simple analysis of the articles published in the leading clinical review, the New England Journal of Medicine, shows that these two subjects are the main items. In the treatment of atrial fibrillation, Canadian investigators in the CTAF study, showed that amiodarone was more effective than Sotalol or Propafenone for the prevention of recurrences of atrial fibrillation in a population of 403 patients followed up for an average of 16 months. There were 35% of recurrences in the amiodarone group compared with 63% in the Sotalol and Propafenone group. Two articles demonstrated the value of automatic external defibrillation in the prevention of sudden arrhythmic death, especially when used in a relatively confined space such as an aeroplane or a casino. These two American Publications showed the value of this approach for a rapid recovery after ventricular fibrillation, the rapidity being the only guarantee of a high survival rate after hospital discharge, about 40% in this series. These various studies should be placed in the perspective of the general changes in treatment of these two pathologies : the treatment of atrial fibrillation is becoming progressively more hybrid, the same patient being considered at different moments for pharmacological antiarrhythmic therapy, ablation or pacing : arrhythmic sudden death is of increasing concern, either with curative treatment by external automatic defibrillation or by preventive therapy with the implantable defibrillator, the trend being towards "prophylactic" indications in patients in whom the high risk of sudden death has been determined.
