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

• Published in: Pacing and clinical electrophysiology Vol. 21; no. 5; pp. 1133 - 1145
• Main Authors: KASSOTIS, JOHN, COSTEAS, CONSTANTINOS, BLITZER, MARK, REIFFEL, JAMES A.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-05-1998
• Subjects: Algorithms; Anti-Arrhythmia Agents - adverse effects; Anti-Arrhythmia Agents - therapeutic use; antiarrhythmic drugs; atrial fibrillation; Atrial Fibrillation - drug therapy; Atrial Fibrillation - physiopathology; Atrial Fibrillation - therapy; cardioversion; Combined Modality Therapy; Electric Countershock; Heart Rate - drug effects; Humans; Patient Care Planning; rate control; Risk Factors
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/j.1540-8159.1998.tb00160.x

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.