Management of atrial fibrillation: therapeutic options and clinical decisions

Atrial fibrillation (AF) is the most common, sustained tachyarrhythmia seen in clinical practice. Although it is not immediately life threatening, AF can cause troublesome symptoms and poses a risk of stroke. The patient’s clinical status is often complicated by the presence of other cardiovascular...

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Bibliographic Details
Published in:The American journal of cardiology 2000-05, Vol.85 (10), p.3-11
Main Author: Prystowsky, Eric N.
Format: Article
Language:English
Subjects:
Ambulatory Care
Anti-Arrhythmia Agents - therapeutic use
Anticoagulants - therapeutic use
Atrial Fibrillation - drug therapy
Atrial Fibrillation - physiopathology
Atrial Fibrillation - therapy
Biological and medical sciences
Cardiac arrhythmia
Cardiac dysrhythmias
Cardiology. Vascular system
Catheter Ablation
Electric Countershock
Electrocardiography
Heart
Hemodynamics
Humans
Medical sciences
Therapy
Treatment Outcome
Warfarin - therapeutic use
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Description
Summary:Atrial fibrillation (AF) is the most common, sustained tachyarrhythmia seen in clinical practice. Although it is not immediately life threatening, AF can cause troublesome symptoms and poses a risk of stroke. The patient’s clinical status is often complicated by the presence of other cardiovascular or concomitant diseases. As a result, management of the patient with AF involves many questions and choices, all of which must be individualized. There are 3 general strategies for the management of patients with AF, including (1) restoration and maintenance of sinus rhythm, (2) control of ventricular rate, and (3) prevention of stroke. More than 1 strategy may be appropriate in some patients. Furthermore, either pharmacologic or nonpharmacologic options can be chosen in certain situations. Although some data from randomized clinical trials are available to aid in clinical decision-making, only the benefits of anticoagulation are supported by substantial evidence. This article explores practical approaches to several management issues and scenarios for which there are limited relevant clinical data. These include: (1) patient selection for ventricular rate control and assessment of treatment, (2) choice of antiarrhythmic drug for maintenance of sinus rhythm, (3) inpatient versus outpatient initiation of therapy, (4) definition of antiarrhythmic drug success, (5) methods of transthoracic direct cardioversion, and (6) prediction and prevention of AF after cardiac surgery.
ISSN:0002-9149
1879-1913
DOI:10.1016/S0002-9149(00)00908-5