Pharmacologic and nonpharmacologic options to maintain sinus rhythm: guideline-based and new approaches.
Atrial fibrillation is a common arrhythmia in patients with heart failure and is responsible for substantial morbidity and mortality. Restoration and preservation of sinus rhythm, therefore, has a premium. Of the numerous treatment options available, many must be avoided because of their potential for adverse effects or because of limited proof of efficacy in defined populations. Published guidelines provide help by synthesizing clinical trial data into a recommended approach. This article summarizes current information regarding the best methods applicable to patients with left ventricular dysfunction for rate control, sinus rhythm restoration and maintenance, and stroke prevention. New and evolving therapies and how they might fit into the evolving treatment paradigm are also briefly reviewed.
Kowey
Peter R
PR
Department of Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania 19096, USA. koweyp@casep.com
Yan
Gan Xin
GX
Winkel
Elaine
E
Kao
Walter
W
D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation; D005424:Flecainide / Q000627:therapeutic use; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D010627:Phenethylamines / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011405:Propafenone / Q000627:therapeutic use; D011802:Quinidine / Q000627:therapeutic use; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013449:Sulfonamides / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000503:physiopathology
D000889:Anti-Arrhythmia Agents; D010627:Phenethylamines; D013449:Sulfonamides; C067192:ibutilide; D011405:Propafenone; D011802:Quinidine; D005424:Flecainide; D000638:Amiodarone; C063533:dofetilide