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Rhythm Management in Atrial Fibrillation—With a Primary Emphasis on Pharmacologic Therapy: Part 3

Rhythm Management in Atrial Fibrillation—With a Primary Emphasis on Pharmacologic Therapy: Part 3 Atrial fibrillation (AF) is the most common, sustained, symptomatic tachyarrhythmia that clinicians are called upon to manage. Management strategies include ventricular rate control coupled with anticoagulation, versus restoration and maintenance of sinus rhythm. Rate control may be achieved pharmacologically, with agents that impair AV nodal conduction directly and/or by increasing parasympathetic/sympathetic balance, or by modifying or ablating the A V nodal region anatomically. Rhythm control may be achieved by electrical or pharmacologic conversion followed by maintenance of sinus rhythm by pharmacologic (or occasionally ablative) therapies. This article will present current approaches to rate and rhythm control issues in atrial fibrillation. Parts 1 and 2, published previously, dealt with rate control and with the restoration of sinus rhythm. Part 3, the current article, details the selection process of choosing a therapy to maintain sinus rhythm, including the likelihood of success, the risks of therapy, and individualization of therapy as dependent upon the nature of the structural heart disease present. It also discusses nonpharmacologic approaches that have been recently developed or are undergoing development. One suggested drug selection algorithm is provided. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Pacing and Clinical Electrophysiology Wiley

Rhythm Management in Atrial Fibrillation—With a Primary Emphasis on Pharmacologic Therapy: Part 3

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References (188)

Publisher
Wiley
Copyright
Copyright © 1998 Wiley Subscription Services, Inc., A Wiley Company
ISSN
0147-8389
eISSN
1540-8159
DOI
10.1111/j.1540-8159.1998.tb00160.x
Publisher site
See Article on Publisher Site

Abstract

Atrial fibrillation (AF) is the most common, sustained, symptomatic tachyarrhythmia that clinicians are called upon to manage. Management strategies include ventricular rate control coupled with anticoagulation, versus restoration and maintenance of sinus rhythm. Rate control may be achieved pharmacologically, with agents that impair AV nodal conduction directly and/or by increasing parasympathetic/sympathetic balance, or by modifying or ablating the A V nodal region anatomically. Rhythm control may be achieved by electrical or pharmacologic conversion followed by maintenance of sinus rhythm by pharmacologic (or occasionally ablative) therapies. This article will present current approaches to rate and rhythm control issues in atrial fibrillation. Parts 1 and 2, published previously, dealt with rate control and with the restoration of sinus rhythm. Part 3, the current article, details the selection process of choosing a therapy to maintain sinus rhythm, including the likelihood of success, the risks of therapy, and individualization of therapy as dependent upon the nature of the structural heart disease present. It also discusses nonpharmacologic approaches that have been recently developed or are undergoing development. One suggested drug selection algorithm is provided.

Journal

Pacing and Clinical Electrophysiology – Wiley

Published: May 1, 1998

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