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Acute Treatment of Atrial Fibrillation and Flutter

Atrial fibrillation is the most commonly occurring cardiac rhythm disorder, yet it is often highly symptomatic and frequently responds poorly to standard therapies. [1] There are 3 major reasons for prompt therapy of acute atrial fibrillation or atrial flutter: (1) relief of symptoms, (2) risk reduction, and (3) prevention of electrical remodeling. The spectrum of symptomatology is broad, from an asymptomatic condition in older, less-active individuals with slower ventricular response, to severe, debilitating, even life-threatening symptoms. Most commonly, symptoms associated with atrial fibrillation include palpitation, dyspnea, lightheadedness, and fatigue, while some patients experience more serious symptoms, such as angina, heart failure, and syncope. These differences need to be taken into account when choosing medical therapy. Risks of untreated atrial fibrillation and flutter include systemic thromboemboli and cerebrovascular accidents, induction of ventricular tachycardia, and tachycardia-induced ventricular dysfunction. The latter effect generally requires substantial time to develop, unless preexistent left ventricular dysfunction is present. Recent research reinforces the adage that “atrial fibrillation begets atrial fibrillation.” [2] In a goat model of atrial fibrillation, repeated induction of atrial fibrillation with rapid burst pacing led to progressive shortening of the atrial refractory period over several days and was associated with increasingly longer http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The American Journal of Cardiology Elsevier
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