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Atrial Fibrillation Management: A Comprehensive Review with a Focus on Pharmacotherapy, Rate, and Rhythm Control Strategies

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Abstract

Atrial fibrillation (AF) is an increasingly common arrhythmia encountered in clinical practice that leads to a substantial increase in utilization of healthcare services and a decrease in the quality of life of patients. The prevalence of AF will continue to increase as the population ages and develops cardiac comorbidities; thus, prompt and effective treatment is important to help mitigate systemic resource utilization. Treatment of AF involves two tenets: prevention of stroke and systemic embolism and symptom control with either a rate or a rhythm control strategy. Historically, due to the safe nature of medications like beta-blockers and non-dihydropyridine calcium channel blockers, used in rate control, it has been the initial strategy used for symptom control in AF. Newer data suggest that a rhythm control strategy with antiarrhythmic medications with or without catheter ablation may lead to a reduction in major adverse cardiovascular events, particularly in patients newly diagnosed with AF. Modulation of factors that promote AF or its complications is another important aspect of the overall holistic management of AF. This review provides a comprehensive focus on the management of patients with AF and an in-depth review of pharmacotherapy of AF in the rate and rhythm control strategies.

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Authors and Affiliations

  1. Department of Pharmacy, WVU Medicine, 1 Medical Center Drive, Morgantown, WV, 26505, USA

    Jordan L. Lacoste, Thomas W. Szymanski & Galen Kabulski

  2. Department of Internal Medicine, West Virginia University School of Medicine, Morgantown, WV, USA

    Juan Carlo Avalon

  3. Department of Pediatrics, WVU School of Medicine, Morgantown, WV, USA

    Utkarsh Kohli

  4. Department of Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, LA, USA

    Nassir Marrouche & Atul Singla

  5. Department of Cardiovascular and Thoracic Surgery, WVU School of Medicine, Morgantown, WV, USA

    Sudarshan Balla

  6. Center for Advanced Atrial Fibrillation Therapies at Aurora St. Luke’s Medical Center, Milwaukee, WI, 53215, USA

    Arshad Jahangir

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  1. Jordan L. Lacoste
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  2. Thomas W. Szymanski
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  3. Juan Carlo Avalon
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  4. Galen Kabulski
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  5. Utkarsh Kohli
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  6. Nassir Marrouche
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  7. Atul Singla
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  9. Arshad Jahangir
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Correspondence to Jordan L. Lacoste.

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Lacoste, Szymanski, Avalon, Kabulski, Kohli, Marrouche, Singla, Balla, and Jahangir declare that they have no potential conflicts of interest that might be relevant to the contents of this article.

Author contributions

JLL was involved with conceptualization, writing, editing, reviewing, and administration. TWS was involved with writing, editing, and reviewing. JCA was involved with writing, editing, and reviewing. GK was involved with writing, editing, and reviewing. UK was involved with editing and reviewing. NM was involved with reviewing. AS was involved with reviewing. SB was involved with editing, reviewing, and conceptualization. AJ was involved with editing, reviewing, and conceptualization.

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Lacoste, J.L., Szymanski, T.W., Avalon, J.C. et al. Atrial Fibrillation Management: A Comprehensive Review with a Focus on Pharmacotherapy, Rate, and Rhythm Control Strategies. Am J Cardiovasc Drugs 22, 475–496 (2022). https://doi.org/10.1007/s40256-022-00529-6

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  • DOI: https://doi.org/10.1007/s40256-022-00529-6

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