[Cardioversion for atrial fibrillations: not better than ventricular rate control].
Atrial fibrillation is a frequent cardiac arrhythmia in the elderly, which can be treated either by rate control, or by rhythm control through chemical or electrical cardioversion. Rate control is easily achieved, but leaves the arrhythmia with its inherent risk of heart failure and stroke intact. Although rhythm control is logistically more complex to obtain, it does restore normal sinus rhythm. However, dangerous antiarrhythmics are then needed to maintain this. Recently, two randomised trials showed that rate control is not inferior to rhythm control. Restoration and maintenance of sinus rhythm was accompanied by a higher incidence of death, ventricular arrhythmias, heart failure, stroke and the need for permanent pacemaker implantation. Recurrent atrial fibrillation can be treated optimally by rate control through digitalis, beta-blockers or calcium antagonists, accompanied by oral anticoagulation. Once the sinus rhythm has been restored, oral anticoagulation should be continued.
Verheugt
F W A
FW
Universitair Medisch Centrum St Radboud, afd. Cardiologie, Postbus 9101, 6500 HB Nijmegen. f.verheugt@cardio.umcn.nl
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000628:therapy; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002561:Cerebrovascular Disorders / Q000517:prevention & control; D004071:Digitalis Glycosides / Q000627:therapeutic use; D006801:Humans; D010138:Pacemaker, Artificial; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants; D002121:Calcium Channel Blockers; D004071:Digitalis Glycosides
Cardioversie voor atriumfibrilleren: niet beter dan ventrikelfrequentieverlaging.