Pharmacologic approaches to rhythm versus rate control in atrial fibrillation--where are we now?

International Journal of Cardiology
D George Wyse

Abstract

Until recently, contemporary drug treatment of atrial fibrillation (AF) focused primarily on restoration and maintenance of sinus rhythm, predicated on the belief that if AF is abolished then problems associated with AF would be abolished too. Recently completed clinical trials using drug therapy and comparing maintenance of sinus rhythm with control of ventricular rate have challenged this assumption, showing that simple control of ventricular rate with anticoagulation is an acceptable primary therapy, notably in older patients with persistent AF, minimally symptomatic or asymptomatic, and at increased risk for thromboembolic events. However, rate control and anticoagulation is not a panacea; existing trial results should not be interpreted to mean all patients should be treated with the rate control approach. Despite the limited efficacy and poor safety of current antiarrhythmic drugs, strategies for maintenance of sinus rhythm remain justified in many patients, such as those with first-episode AF, highly symptomatic patients, younger patients, and those with a history of congestive heart failure (CHF). Commonly used current and some investigational agents designated for "rhythm control" have enough pharmacologic overlap with...Continue Reading

References

Jun 4, 1992·The American Journal of Cardiology·B H Sarter, F E Marchlinski
Apr 1, 1991·Annals of Internal Medicine·R H Falk, J I Leavitt
Sep 1, 1987·Archives of Internal Medicine·P A WolfW B Kannel
Jul 1, 1967·British Heart Journal·B Lown
Jan 1, 1995·The American Journal of Cardiology·K A EllenbogenB S Stambler
Aug 1, 1994·The American Journal of Cardiology·C D FurbergP M Rautaharju
Dec 15, 1996·The American Journal of Cardiology·E G DaoudF Morady
Sep 1, 1996·Food and Chemical Toxicology : an International Journal Published for the British Industrial Biological Research Association·T B AdamsR A Ford
Apr 16, 1998·The American Journal of Cardiology·A J CammC M Pratt
Nov 3, 2001·Journal of the American College of Cardiology·M M GallagherA J Camm
Apr 30, 2002·American Journal of Epidemiology·Wendy A WattigneyJanet B Croft
Dec 6, 2002·The New England Journal of Medicine·D G WyseUNKNOWN Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators
Dec 6, 2002·The New England Journal of Medicine·Isabelle C Van GelderUNKNOWN Rate Control versus Electrical Cardioversion for Persistent Atrial Fibrillation Study Group
Jan 22, 2003·Journal of the American College of Cardiology·Philippe ChevalierPaul Touboul
Aug 27, 2003·Circulation Journal : Official Journal of the Japanese Circulation Society·Takeshi YamashitaUNKNOWN J-RHYTHM Investigators
Jan 13, 2004·Journal of the American College of Cardiology·Carsten W IsraelStefan H Hohnloser
Aug 11, 2004·Chest·Grzegorz OpolskiUNKNOWN Investigators of the Polish How to Treat Chronic Atrial Fibrillation Study
Aug 17, 2004·Journal of Cardiovascular Pharmacology and Therapeutics·Amit VoraBramah N Singh
Aug 24, 2004·European Heart Journal·Monica PattenUNKNOWN SOPAT Investigators
Jan 27, 2005·The American Journal of Cardiology·Brian OlshanskyUNKNOWN NHLBI AFFIRM Investigators
Mar 22, 2005·Current Problems in Cardiology·A Hersi, D G Wyse
Apr 27, 2005·Heart Rhythm : the Official Journal of the Heart Rhythm Society·A John Camm, Irina Savelieva
Jun 2, 2005·JAMA : the Journal of the American Medical Association·Oussama M WazniAndrea Natale
Aug 12, 2005·The New England Journal of Medicine·Jack Rubinstein
Oct 29, 2005·Progress in Cardiovascular Diseases·D George Wyse

❮ Previous
Next ❯

Citations

Apr 1, 2010·Circulation Journal : Official Journal of the Japanese Circulation Society·Masanori KonishiMitsuaki Isobe
Nov 2, 2014·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Valentina D A CorinoLeif Sörnmo
May 3, 2007·Journal of Cardiovascular Electrophysiology·D George Wyse
Jan 25, 2011·Clinical Cardiology·Walid Saliba, Oussama M Wazni

❮ Previous
Next ❯

Related Concepts

Related Feeds

Cardiovascular Disease Pathophysiology

Cardiovascular disease involves several different processes that contribute to the pathological mechanism, including hyperglycemia, inflammation, atherosclerosis, hypertension and more. Vasculature stability plays a critical role in the development of the disease. Discover the latest research on cardiovascular disease pathophysiology here.

Atrial Fibrillation

Atrial fibrillation is a common arrhythmia that is associated with substantial morbidity and mortality, particularly due to stroke and thromboembolism. Here is the latest research.

Cardiac Conduction System

The cardiac conduction system is a specialized tract of myocardial cells responsible for maintaining normal cardiac rhythm. Discover the latest research on the cardiac conduction system here.

Atrial Filbrillation

Atrial fibrillation refers to the abnormal heart rhythm characterized by rapid and irregular beating of the atria. Here is the latest research.

Antihypertensive Agents: Mechanisms of Action

Antihypertensive drugs are used to treat hypertension (high blood pressure) which aims to prevent the complications of high blood pressure, such as stroke and myocardial infarction. Discover the latest research on antihypertensive drugs and their mechanism of action here.

Arrhythmia

Arrhythmias are abnormalities in heart rhythms, which can be either too fast or too slow. They can result from abnormalities of the initiation of an impulse or impulse conduction or a combination of both. Here is the latest research on arrhythmias.

Anti-Arrhythmic Drug Therapies

Anti-arrhythmic drugs are used to prevent abnormal heart rhythms. These medications are used in conditions including, ventricular tachycardia, ventricular fibrillation and atrial fibrillation. Discover the latest research on anti-arrhythmic drug therapies here.

Antiarrhythmic Agents: Mechanisms of Action

Understanding the mechanism of action of antiarrhythmic agents is essential in developing new medications as treatment of cardiac arrhythmias is currently limited by the reduced availability of safe and effective drugs. Discover the latest research on Antiarrhythmic Agents: Mechanism of Action here.