Advances in the treatment of atrial fibrillation.
Management of atrial fibrillation (AF) has changed greatly in the past 10 years. The advent of a greater understanding of the pathophysiology of AF has resulted in major therapeutic breakthroughs, both in invasive and non-invasive strategies. New antiarrhythmic agents with fewer side effects, new anticoagulants and technical advances in ablation have changed the treatment of this condition. Molecular modification of the highly effective amiodarone, to improve safety and tolerability, has produced promising analogues such as Dronedarone. Although this drug seems less effective than amiodarone in preventing AF recurrence, the drug presented an interesting data on reduction of stroke and cardiovascular death, a novel effect that needs further investigation. New antiarrhythmics with atria selectiveness such Vernakalant, might be useful for cardioversion in AF without ventricular proarrhythmia. Dabigatran, a prodrug that directly inhibits thrombin, represents an alternative to warfarin for anticoagulant treatment in selected patients. In AF ablation, technological advances are sure to result in the necessary improvements in the safety and procedures efficacy. These technologies include ablation catheters designed to electrically isolate the pulmonary veins with improved safety, efficacy, speed, and precision and improved imaging and electrical mapping systems. Although pulmonary vein isolation remains essential for most ablation procedures, the role of substrate modification has taken on increasing importance. In this article, we review the advances in the treatment of AF, focus on the new medications and advances in invasive procedures.
Arrhythmia Service, Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, ON, Canada.
R I
RI
Miranda
C S
CS
Simpson
K A
KA
Michael
H
H
Abdollah
A M
AM
Baranchuk
D P
DP
Redfearn
D000638:Amiodarone / Q000031:analogs & derivatives / Q000627:therapeutic use; D000840:Anisoles / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D001562:Benzimidazoles / Q000627:therapeutic use; D017115:Catheter Ablation; D000069604:Dabigatran; D000077764:Dronedarone; D004359:Drug Therapy, Combination; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D011759:Pyrrolidines / Q000627:therapeutic use; D016896:Treatment Outcome; D015091:beta-Alanine / Q000031:analogs & derivatives / Q000627:therapeutic use
D000840:Anisoles; D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants; D001562:Benzimidazoles; D011759:Pyrrolidines; D015091:beta-Alanine; C524581:vernakalant; D000069604:Dabigatran; D000077764:Dronedarone; D000638:Amiodarone