Document Detail


Pharmacological cardioversion of atrial fibrillation: current management and treatment options.
MedLine Citation:
PMID:  15563247     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Atrial fibrillation (AF) is the most common form of arrhythmia, carrying high social costs. It is usually first seen by general practitioners or in emergency departments. Despite the availability of consensus guidelines, considerable variations exist in treatment practice, especially outside specialised cardiological settings. Cardioversion to sinus rhythm aims to: (i) restore the atrial contribution to ventricular filling/output; (ii) regularise ventricular rate; and (iii) interrupt atrial remodelling. Cardioversion always requires careful assessment of potential proarrhythmic and thromboembolic risks, and this translates into the need to personalise treatment decisions. Among the many clinical variables that affect strategy selection, time from onset is crucial. In selected patients, pharmacological cardioversion of recent-onset AF can be a safely used, feasible and effective approach, even in internal medicine and emergency departments. In most cases of recent-onset AF, pharmacological cardioversion provides an important--and probably more cost effective--alternative to electrical cardioversion, which can then be employed as a second-line therapy for nonresponders. Class IC agents (flecainide or propafenone), which can be safely used in hospitalised patients with recent-onset AF without left ventricular dysfunction, can provide rapid conversion to sinus rhythm after either intravenous administration or oral loading. Although intravenous amiodarone requires longer conversion times, it is still the standard treatment for patients with heart failure. Ibutilide also provides good conversion rates and could be used for AF patients with left ventricular dysfunction (were it not for high costs). For long-lasting AF most pharmacological treatments have only limited efficacy and electrical cardioversion remains the gold standard in this setting. However, a widely used strategy involves pretreatment with amiodarone in the weeks before planned electrical cardioversion: this provides optimal prophylaxis and can sometimes even restore sinus rhythm. Dofetilide may also be capable of restoring sinus rhythm in up to 25-30% of patients and can be used in patients with heart failure. The potential risk of proarrhythmia increases the need for careful therapeutic decision making and management of pharmacological cardioversion. The results of recent trials (AFFIRM [Atrial Fibrillation Follow-up Investigation of Rhythm Management] and RACE [Rate Control versus Electrical Cardioversion for Persistent Atrial Fibrillation]) on rate versus rhythm control strategies in the long term have led to a generalised shift in interest towards rate control. Although carefully designed studies are required to better define the role of pharmacological rhythm control in specific AF settings, this alternative option remains a recommendable strategy for many patients, especially those in acute care.
Authors:
Giuseppe Boriani; Igor Diemberger; Mauro Biffi; Cristian Martignani; Angelo Branzi
Related Documents :
11542517 - Changes in the loco-regional cerebral blood flow (r.c.b.f.) during a simulation of weig...
2044547 - Ventricular fibrillation in the wolff-parkinson-white syndrome.
16820627 - Multislice computed tomography accurately quantifies left atrial size and function afte...
18676037 - Inducibility of atrial fibrillation during electrophysiologic evaluation is associated ...
8339407 - Continuous 12-lead st-segment recovery analysis in the tami 7 study. performance of a n...
8680277 - Pseudoaneurysm of the free wall of the left ventricle without obstruction of major coro...
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Drugs     Volume:  64     ISSN:  0012-6667     ISO Abbreviation:  Drugs     Publication Date:  2004  
Date Detail:
Created Date:  2004-11-25     Completed Date:  2005-03-10     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7600076     Medline TA:  Drugs     Country:  New Zealand    
Other Details:
Languages:  eng     Pagination:  2741-62     Citation Subset:  IM    
Affiliation:
Institute of Cardiology, University of Bologna, Azienda Ospedaliera S. Orsola-Malpighi, Bologna, Italy. cardio1@med.unibo.it
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Anti-Arrhythmia Agents / administration & dosage,  adverse effects,  therapeutic use*
Atrial Fibrillation / complications,  drug therapy*
Clinical Trials as Topic
Drug Administration Schedule
Humans
Risk Factors
Thromboembolism / etiology
Chemical
Reg. No./Substance:
0/Anti-Arrhythmia Agents

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


Previous Document:  The role of olmesartan medoxomil in the management of hypertension.
Next Document:  Viral prophylaxis in organ transplant patients.