[Atrial fibrillation: current trends].
The author analyses the current relevance of atrial fibrillation (AF), an arrhythmia no longer viewed as a benign situation, being the first arrhythmic cause of hospitalisation. New data related to the conversion of this arrhythmia to sinus rhythm is reviewed, namely internal atrial defibrillation with low energy shocks and the efficacy of new drugs such as ibutilide. The current role of transesophageal echocardiography in permitting a shorter scheme of anticoagulation before the DC shock is also reviewed. About the importance of maintaining sinus rhythm, the author mentions new data from the Framingham Study showing that AF is an independent predictor of mortality. Attention is drawn to the important role of AF duration before cardioversion, since an "electrical remodeling" does occur, quickly reducing the probability of maintaining sinus rhythm. Concerning the limitations of pharmacological therapy, the author mentions the AFFIRM study that, in a few years, will hopefully solve the controversy concerning the best strategy--maintenance of sinus rhythm versus rate control. Also concerning pharmacological therapy, the author mentions two trials suggestive of the efficacy of amiodarone and dofetilide in AF patients with congestive heart failure. Regarding non-pharmacological options, reference is made to recent advances in surgery of AF and to the search for more simplified operative procedures to reduce intervention risks and duration. To overcome the difficulties in reproducing the maze operation with catheter ablation, new alternatives have appeared, such as energy application inside the pulmonary veins, known as the source of most ectopic atrial beats that trigger AF episodes. The author concludes that since AF is a heterogeneous entity, different therapies must exist, but the pharmacological approach will maintain a central role and non pharmacological therapies should be used as an alternative in refractory cases.
Bonhorst
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Serviço de Cardiologia, Hospital de Santa Cruz.
D001281:Atrial Fibrillation / Q000503:physiopathology / Q000628:therapy; D002908:Chronic Disease; D005544:Forecasting; D006801:Humans