title: Maintaining stability of sinus rhythm in atrial fibrillation: antiarrhythmic drugs versus ablation.
abstract: In managing atrial fibrillation, the main therapeutic strategies include rate control, termination of the arrhythmia, and pr vention of recurrences and thromboembolic events. Rate control with digoxin, b-blockers, verapamil, and diltiazem may be preferred in drug refractory and sedentary patients with markedly dilated left atrium and atrial fibrillation of long duration. Drugs useful in the maintenance of sinus rhythm include quinidine, procainamide, disopyramide, sotalol, amiodarone, dofetilide, flecainide, and propafenone. In patients with structural heart disease, the class III antiarrhythmics are the initial drugs of choice, given their neutral effects on survival in a post-myocardial infarction and congestive heart failure population. Due to high recurrence rates with pharmacologic therapy, nonpharmacologic options of therapy include atrioventricular junction ablation, atrial defibrillators, catheter ablation of pulmonary vein foci, and attempts to perform an atrial Maze procedure using catheters. Hybrid therapy using drugs in combination with nonpharmacologic approaches will be used more frequently in the future for refractory patients.
authors.affiliation: Hershey Medical Center, Division of Cardiology, 500 University Drive, Hershey, PA 17033, USA. gnaccarelli@psu.edu
authors.forename: Gerald V
authors.initials: GV
authors.lastname: Naccarelli
authors.forename: John
authors.initials: J
authors.lastname: Hynes
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Wolbrette
authors.forename: Luna
authors.initials: L
authors.lastname: Bhatta
authors.forename: Mazhar
authors.initials: M
authors.lastname: Khan
authors.forename: Jerry
authors.initials: J
authors.lastname: Luck
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D017115:Catheter Ablation; D006329:Heart Conduction System / Q000187:drug effects / Q000473:pathology* / Q000601:surgery; D006801:Humans; D014481:United States / Q000453:epidemiology
chemical_list: D000889:Anti-Arrhythmia Agents