Recently therapeutic options for the treatment of atrial fibrillation (AF) became more extent, as pharmacological and mapping technology develop. However, the treatment for the restoration and maintenance of sinus rhythm in patients with persistent AF and progressed atrial remodeling remains unsatisfied even utilizing both pharmacological and nonpharmacological therapies.
Up to present, there are a total of 5 clinical randomized trials investigating which therapeutic strategy (rhythm control or rate control) is superior in terms of improvement in the patients' prognosis and quality of life. In all the trials, there were no significant differences in the incidence of end-points including all-cause death, embolic and hemorrhagic events between two strategies, although the cumulative mortality tended to be higher for the rhythm control strategy in AFFIRM trial. On the contrary, exercise tolerance (6 minutes walk) was improved to the greater degree for the rhythm control strategy in PIAF trial. Because most of these trials recruited the patients with high risk patients of thrombo-embolic complications such as older age, persistent or chronic AF, reduced cardiac function and so on, it is suggested that the rhythm control therapy might improve the QOL and even mortality, by selecting candidates appropriately for the rhythm control therapy.

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A 69 year-old man presented with interstitial pneumonia associated with rheumatoid arthritis (RA). About 7 months before the appearance of signs of arthritis, his chest roentgenogram showed interstitial shadows. Serological examination at that time already revealed high titers of antinuclear antibody and rheumatoid factor. The high-resolution chest CT showed a pattern of interstitial pneumonia with patchy thickening of the pleura. Bronchoalveolar lavage revealed increases in neutrophils and lymphocytes, suggesting nonusual interstitial pneumonia. Transbronchial biopsy showed a histopathologic pattern of fibrotic nonspecific interstitial pneumonia. On admission, the patient suffered persistent arthritis in multiple joints, consistent with RA. At that time, lung involvement preceding RA was diagnosed. Clinically, it is important to differentiate interstitial pneumonia associated with collagen vascular disease (CVD-IP) from idiopathic interstitial pneumonias (IIPs), because prognosis and treatment of these two diseases is different. However, a patient may sometimes present the clinical features of IIPs and later develop a defined connective tissue disease. Therefore, it is always necessary to consider the possibility of CVD-IP when following patients with IIPs.

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