Document Detail


Paroxysmal atrial fibrillation.
MedLine Citation:
PMID:  11744787     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
There has been a tendency to treat paroxysmal atrial fibrillation (PAF) in a similar way to sustained AF, but treatment objectives may be very different. We discuss current definitions, epidemiology, pathophysiology and natural history of PAF, and review evidence for its treatment and management. PAF comprises between 25% and 62% of cases of AF, with similar underlying causes to those in sustained AF. The main objective of management is prevention of paroxysms and long-term maintenance of sinus rhythm, and Class 1c drugs are highly effective, although beta-blockers are useful alternatives. If patients have severe coronary artery disease or poor ventricular function, amiodarone is probably the drug of choice. Although randomized controlled trials of thromboprophylaxis in patients with paroxysmal AF per se are lacking, the approach to patients with paroxysmal AF should be similar to that in patients with sustained AF, with warfarin for 'high risk' patients and aspirin for those at 'low risk'. Non-pharmacological therapeutic options, including pacemakers, electrophysiological techniques and the implantable atrial defibrillator, show great promise. Despite paroxysmal AF being a common condition, management strategies are limited by evidence from small randomized trials, with inconsistencies over the definition of the arrhythmia and the inclusion of only symptomatic subjects. Evidence for antithrombotic therapy is also based on epidemiological studies and subgroup analyses of the large randomized trials.
Authors:
G Y Lip; F L Hee
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  QJM : monthly journal of the Association of Physicians     Volume:  94     ISSN:  1460-2725     ISO Abbreviation:  QJM     Publication Date:  2001 Dec 
Date Detail:
Created Date:  2001-12-17     Completed Date:  2002-02-19     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9438285     Medline TA:  QJM     Country:  England    
Other Details:
Languages:  eng     Pagination:  665-78     Citation Subset:  IM    
Affiliation:
Haemostasis, Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK. G.Y.H.LIP@bham.ac.uk
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / therapeutic use
Aged
Anti-Arrhythmia Agents / therapeutic use
Anticoagulants / therapeutic use
Atrial Fibrillation / complications,  physiopathology,  therapy*
Case-Control Studies
Catheter Ablation
Defibrillators, Implantable
Electric Countershock
Electrocardiography
Female
Humans
Male
Pacemaker, Artificial
Randomized Controlled Trials as Topic
Stroke / etiology
Thromboembolism / etiology
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Anti-Arrhythmia Agents; 0/Anticoagulants

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


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