Abstract
Atrial fibrillation (AF) is the most common sustained tachyarrhythmia encountered in clinical practice. The management of AF remains associated with many challenges that make its treatment a vexing problem. However, in recent years extraordinary progress has been made in the understanding and management of AF. In general, antiarrhythmic drugs for rhythm control have been disappointing. We have a better understanding of pharmacologic cardioversion and this has led to newer strategies, such as intermittent therapy. Several studies have been completed comparing pharmacologic rhythm control with pharmacologic heart rate control. There is also an emerging body of evidence concerning the value of adjunctive drug use for rhythm control using drugs that would not usually be considered to be antiarrhythmic. Finally, antithrombotic therapy is an increasingly important part of the medical management of AF. This article summarizes the results of many of the recent publications and their clinical implications concerning management of this common rhythm disorder.
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References and Recommended Reading
Boriani G, Diemberger I, Bif. M, et al.: Pharmacological cardioversion of atrial fibrillation: current management and treatment options. Drugs 2004, 64:2741–2762. A comprehensive review of the principles of and drugs used for pharmacologic cardioversion.
Roy D, Rowe BH, Stiell IG, et al.: A randomized, controlled trial of RSD 1235, a novel anti-arrhythmic agent, in the treatment of recent onset atrial fibrillation. J Am Coll Cardiol 2004, 44:2355–2361.
Miller MR, McNamara RL, Segal JB, et al.: Efficacy of agents for pharmacologic conversion of atrial fibrillation and subsequent maintenance of sinus rhythm. J Fam Prac 2000, 49:1033–1046. A review of the Efficacy of currently available antiarrhythmic drugs used for the maintenance of sinus rhythm.
Singh BN, Singh SN, Reda DJ, et al.: Sotalol Amiodarone Atrial Fibrillation Efficacy Trial (SAFE-T) investigators. N Engl J Med 2005, 352:1861–1872.
Fuster V, Ryden LE, Asinger RW, et al.: ACC/AHA/ESC Guidelines for the management of patients with atrial fibrillation. A report of the American Heart Association Task Force on Practice Guidelines and Policy Conferences (Committee of Develop Guidelines for the Management of Patients with Atrial Fibrillation) developed in collaboration with North American society of Pacing and Electrophysiology. Eur Heart J 2001, 22:1852–1923. This is the currently published version of the American College of Cardiology/American Heart Association/European Society of Cardiology guidelines for treatment of AF. The guidelines have been recently revised.
Pritchett EL, Page RL, Connolly SJ, et al.: Antiarrhythmic effects of azimilide in atrial fibrillation: Efficacy and dose-response. J Am Coll Cardiol 2000, 35:794–802.
Touboul P, Brugada J, Capucci A, et al.: Dronedarone for prevention of atrial fibrillation: a dose-ranging study. Eur Heart J 2003, 24:1481–1487.
Olshansky B, Rosenfeld LE, Warner AL, et al.:The Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study: approaches to control rate in atrial fibrillation. J Am Coll Cardiol 2004, 43:1201–1208.
Wyse DG: Rate control vs rhythm control strategies in atrial fibrillation. Prog Cardiovasc Dis 2005, 48:125–138. A comprehensive review of the rate control and rhythm control strategies and a summary of the trial results comparing these two strategies.
Wyse DG, Simpson CS: Rate control versus rhythm control -- decision making. Can J Cardiol 2005, 21(Suppl B):15B-8B. A summary of factors that favor the selection of rhythm control versus rate control in an individual patient.
Hersi A, Wyse DG: Management of atrial fibrillation. Curr Probl Cardiol 2005, 30:175–233. A more detailed discussion of many of the aspects of AF management that are presented in the present review, along with many more references.
Nieuwlaat R, Capucci A, Camm AJ, et al.: Atrial fibrillation management: a prospective survey in ESC member countries: the Euro Heart Survey on Atrial Fibrillation. Euro Heart J 2005, 26:2422–2434.
Gage BF, Van Walraven C, Pearce L, et al.: Selecting patients with atrial fibrillation for anticoagulation: stroke risk stratification in patients taking aspirin. Circulation 2004, 110:2287–2292.
Gage BF, Waterman AD, Shannon W, et al.: Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 2001, 285:2864 -2870.
Atrial Fibrillation Investigators: Risk factor for stroke and Efficacy of antithrombotic therapy in atrial fibrillation: analysis of pooled data from five randomized controlled trials. Arch Intern Med 1994, 154:1449-1457.
DiMarco JP, Flaker G, Waldo AL, et al.: Factors affecting bleeding risk during anticoagulant therapy in patients with atrial fibrillation: observations from the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Am Heart J 2005, 149:650–656.
Olsson SB, Executive Steering Committee on behalf of the SPORTIF III Investigators: Stroke prevention with the oral direct thrombin inhibitor ximelagatran compared with warfarin in patients with non-valvular atrial fibrillation (SPORTIF III): randomised controlled trial. Lancet 2003, 362:1691–1698.
Albers GW, Diener HC, Frison L, et al.: Ximelagatran vs warfarin for stroke prevention in patients with nonvalvular atrial fibrillation: a randomized trial. JAMA 2005, 293:690–698.
Lozano H, Conde C, Florin T, et al.: Treatment and prevention of atrial fibrillation with nonantiarrhythmic pharmacologic therapy. Heart Rhythm 2005, 2:1000–1007.
Ehrlich JR, Hohnloser SH, Nattel S: Role of angiotensin system and effects of its inhibition in atrial fibrillation: clinical and experimental evidence. Eur Heart J 2006, 27:512–518. A nice review of the current status of nonantiarrhythmic therapies that may help to prevent development of AF or assist in maintaining sinus rhythm.
McMurray J, Køber L, Robertson M, et al.: Antiarrhythmic effect of carvedilol after acute myocardial infarction: results of the Carvedilol Post-Infarct Survival Control in Left Ventricular Dysfunction (CAPRICORN) trial. J Am Coll Cardiol 2005, 45:525–530.
Wachtell K, Lehto M, Gerdts E, et al.: Angiotensin II receptor blockade reduces new-onset atrial fibrillation and subsequent stroke compared to atenolol: the Losartan Intervention For End point reduction in hypertension (LIFE) study. J Am Coll Cardiol 2005, 45:712–719.
Alboni P, Botto GL, Baldi N, et al.: Outpatient treatment of recent-onset atrial fibrillation with the "pill-in-the-pocket" approach. N Engl J Med 2004, 351:2384–2391.
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Hersi, A., Wyse, D.G. Medical management of atrial fibrillation. Curr Cardiol Rep 8, 323–329 (2006). https://doi.org/10.1007/s11886-006-0070-6
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DOI: https://doi.org/10.1007/s11886-006-0070-6