title: Canadian Cardiovascular Society atrial fibrillation guidelines 2010: rate and rhythm management.
abstract: The goals of atrial fibrillation (AF) and atrial flutter (AFL) arrhythmia management are to alleviate patient symptoms, improve patient quality of life, and minimize the morbidity associated with AF and AFL. Arrhythmia management usually commences with drugs to slow the ventricular rate. The addition of class I or class III antiarrhythmic drugs for restoration or maintenance of sinus rhythm is largely determined by patient symptoms and preferences. For rate control, treatment of persistent or permanent AF and AFL should aim for a resting heart rate of <100 beats per minute. Beta-blockers or nondihydropyridine calcium channel blockers are the initial therapy for rate control of AF and AFL in most patients without a history of myocardial infarction or left ventricular dysfunction. Digoxin is not recommended as monotherapy for rate control in active patients. Digoxin and dronedarone may be used in combination with other agents to optimize rate control. The first-choice antiarrhythmic drug for maintenance of sinus rhythm in patients with non structural heart disease can be any one of dronedarone, flecainide, propafenone, or sotalol. In patients with abnormal ventricular function but left ventricular ejection fraction >35%, dronedarone, sotalol, or amiodarone is recommended. In patients with left ventricular ejection fraction <35%, amiodarone is the only drug usually recommended. Intermittent antiarrhythmic drug therapy ("pill in the pocket") may be considered in symptomatic patients with infrequent, longer-lasting episodes of AF or AFL as an alternative to daily antiarrhythmic therapy. Referral for ablation of AF may be considered for patients who remain symptomatic after adequate trials of antiarrhythmic drug therapy and in whom a rhythm control strategy remains desired.
authors.affiliation: University of Calgary/Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada. amgillis@ucalgary.ca
authors.forename: Anne M
authors.initials: AM
authors.lastname: Gillis
authors.forename: Atul
authors.initials: A
authors.lastname: Verma
authors.forename: Mario
authors.initials: M
authors.lastname: Talajic
authors.forename: Stanley
authors.initials: S
authors.lastname: Nattel
authors.forename: Paul
authors.initials: P
authors.lastname: Dorian
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000465:Algorithms; D000638:Amiodarone / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000209:etiology; D001282:Atrial Flutter / Q000188:drug therapy*; D002121:Calcium Channel Blockers / Q000009:adverse effects / Q000627:therapeutic use; D002170:Canada; D002303:Cardiac Output, Low / Q000150:complications / Q000188:drug therapy; D017115:Catheter Ablation; D004077:Digoxin / Q000009:adverse effects / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D000077764:Dronedarone; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005424:Flecainide / Q000009:adverse effects / Q000627:therapeutic use; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy; D010138:Pacemaker, Artificial; D011405:Propafenone / Q000009:adverse effects / Q000627:therapeutic use; D012017:Referral and Consultation; D013015:Sotalol / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D002121:Calcium Channel Blockers; D011405:Propafenone; D004077:Digoxin; D013015:Sotalol; D000077764:Dronedarone; D005424:Flecainide; D000638:Amiodarone