Document Detail

Atrial Fibrillation.
MedLine Citation:
PMID:  11445057     Owner:  NLM     Status:  Publisher    
The conversion of atrial fibrillation (AF) to normal sinus rhythm should be attempted in patients who present with this condition, as long as the cure is not worse than the disease itself. In young patients with normal hearts, AF has a small impact on morbidity and mortality. The primary indication for conversion in this population is often symptoms. In contrast, in patients with diseased hearts or who are older than 65 years, maintaining sinus rhythm may have a favorable impact on stroke risk, ventricular function, and symptoms. In the absence of normal sinus rhythm, these patients should receive anticoagulants. Rate control is the preferred first-line strategy for asymptomatic patients and patients presenting with a history of long-standing, persistent AF, making conversion and maintenance of sinus rhythm unlikely. Rate control may be used in patients who develop AF during an acute systemic illness, which will likely terminate with time or therapy. Conversion to sinus rhythm should be considered in patients with a first episode of AF, as unconverted AF tends to perpetuate itself. Conversion can be attempted if the duration of AF is less than 48 hours or if the patient has received anticoagulants when the duration is not known. Other indications for cardioversion are prolonged episodes in patients with otherwise infrequent episodes of paroxysmal AF, and in patients who refuse to take anticoagulants or in whom anticoagulation is contraindicated. After the patient is converted to sinus rhythm, the decision to initiate chronic drug therapy should be based on the presence of other cardiac and medical diseases that increase the risk of recurrence and serious symptoms in case of recurrence (such as hypertrophic cardiomyopathy or mitral stenosis). It is acceptable to manage patients with new-onset AF and normal cardiac function with cardioversion alone and not initiate chronic antiarrhythmic therapy afterwards. However, in patients with abnormal hearts (coronary artery disease, hypertensive or mitral valvular heart disease, and cardiomyopathy) AF is likely to recur, and such patients should be placed on antiarrhythmic medication.
Jayant Bagai; Boaz Avitall
Related Documents :
19793187 - Warfarin use and the risk of valvular calcification.
20643247 - Obesity and outcomes among patients with established atrial fibrillation.
9854517 - Rate control therapy for atrial fibrillation following coronary artery bypass surgery.
11744787 - Paroxysmal atrial fibrillation.
19775757 - Cochlear abnormalities associated with enlarged vestibular aqueduct anomaly.
16165717 - Expression of inducible nitric oxide synthase and effects of l-arginine on colonic nitr...
Publication Detail:
Journal Detail:
Title:  Current treatment options in cardiovascular medicine     Volume:  3     ISSN:  1534-3189     ISO Abbreviation:  Curr Treat Options Cardiovasc Med     Publication Date:  2001 Aug 
Date Detail:
Created Date:  2001-Jul-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9815942     Medline TA:  Curr Treat Options Cardiovasc Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  261-276     Citation Subset:  -    
Department of Cardiology, University of Illinois at Chicago, M/C 787, Chicago, IL 60612, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Paraneoplastic cerebellar degeneration as the first manifestation of cancer.
Next Document:  Atrial Flutter.