Rhythm Management in Atrial Fibrillation-with a Primary Emphasis on Pharmacological Therapy: Part 2

• Published in: Pacing and clinical electrophysiology Vol. 21; no. 4; pp. 742 - 752
• Main Authors: COSTEAS, CONSTANTINOS, KASSOTIS, JOHN, BLITZER, MARK, REIFFEL, JAMES A.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-04-1998
• Subjects: 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; Defibrillators, Implantable; Electric Countershock; Heart Rate; Humans; rate control
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/j.1540-8159.1998.tb00132.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 AV nodal region anatomically. Rhythm control may be achieved by electrical or pharmacological conversion followed by maintenance of sinus rhythm by pharmacological (or occasionally ablative) therapies. This article will present current approaches to rate and rhythm control issues in AF. Part 1, published previously, dealt with rate control. Part 2, the current article, details approaches to the restoration of sinus rhythm by electrical and pharmacological means. The former may use transthoracic or catheter‐based energy delivery systems. The latter may use intravenous or oral drug approaches. Part 3, to be published in a subsequent edition of PACE will deal with the maintenance of sinus rhythm.