Drug therapy for prevention of atrial fibrillation

The American Journal of Cardiology
P CoumelA Leenhardt

Abstract

Atrial fibrillation is not a homogeneous entity, and many factors are responsible for a number of different behaviors, clinical consequences, and reactions to therapy. Therefore, the conventional evaluation of preventive treatments is not really adapted to provide the correct answers to difficult problems of therapeutic indications, as the 2 components of the benefit-risk ratio are not really known. Like ventricular fibrillation, atrial fibrillation may be primary or secondary to organized tachyarrhythmias, and reentrant flutter or automatic atrial tachycardia may well form the actual target for treatment. The automatic nervous system is never absent as a determinant of the onset of arrhythmia, and the vagal as well as the sympathetic action may predominate and explain why a treatment may or may not be effective in situations that are identical only in appearance. The electrophysiologic milieu formed by the atrial tissue probably accounts for the perpetuation of the process of atrial fibrillation or its self-termination, and drugs themselves may contribute to modify the milieu in a way that in the end may be favorable or not. Finally, the presence or the absence of heart disease and heart failure largely contributes to the stat...Continue Reading

Citations

Oct 7, 1997·Lancet·S M NarayanJ M Smith
Nov 17, 1998·The Journal of Small Animal Practice·N S Moïse
Jul 1, 1997·Clinical Cardiology·L L Mackstaller, J S Alpert
Dec 22, 2009·Journal of Cardiovascular Electrophysiology·Raphael RossoJonathan M Kalman
Oct 1, 2005·Progress in Cardiovascular Diseases·Brian Olshansky
Dec 19, 2003·Asian Cardiovascular & Thoracic Annals·Ravi R KasliwalAtul Bhatia

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