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Updated: Aug 17, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
[Drug treatments of atrial fibrillation]
M Chauvin1, A Koenig, C Brechenmacher
1Service de cardiologie, CMCO, Schiltigheim.
Insights
Atrial fibrillation management involves anticoagulation, rate control, and recurrence prevention. Anticoagulation significantly reduces stroke risk, especially in rheumatic heart disease, while amiodarone offers a favorable benefit/risk ratio for managing this common cardiological issue.
Area of Science:
- Cardiology
- Electrophysiology
- Pharmacology
Context:
- Atrial fibrillation (AF) presents ongoing challenges in anticoagulation, rate control, and recurrence prevention.
- AF is a significant source of embolism, with heightened risk in rheumatic valvular disease and uncompensated cardiac conditions.
- Current management strategies for AF are not fully mastered, necessitating further research and optimized therapeutic approaches.
Purpose:
- To review and synthesize current knowledge on managing atrial fibrillation, focusing on anticoagulation, rhythm control, and preventing recurrence.
- To evaluate the efficacy and risks associated with various treatment modalities for atrial fibrillation.
- To provide guidance on optimal therapeutic strategies based on patient-specific factors and disease characteristics.
Summary:
- Long-term anticoagulation is essential for rheumatic heart disease-related AF and reduces cerebrovascular accidents in other pathologies, including the elderly, even with low-dose vitamin K antagonists.
- Rate control is not always necessary for chronic, well-tolerated AF, especially in the elderly. Medical reduction is preferred over cardioversion for recent, well-tolerated AF.
- Amiodarone demonstrates a favorable benefit/risk profile among available drugs. Recurrence prevention strategies vary, with uncertain efficacy for most drugs except those targeting autonomic nervous system-related AF.
Impact:
- This review aids clinicians in making informed decisions regarding anticoagulation, rhythm control, and recurrence prevention in atrial fibrillation patients.
- Understanding the nuances of AF management can lead to improved patient outcomes, reduced embolic events, and better quality of life.
- Highlights the need for further research into the long-term efficacy of treatments like amiodarone and the management of specific AF subtypes.
Abstract:
Atrial fibrillation is a daily cardiological problem which poses three types of questions, which, though old, are only partially mastered: anticoagulation, reduction and prevention of recurrence. It is a potent source of embolism. The risk is the greatest in patients with rheumatic valvular disease when the fibrillation is recent and when underlying cardiac disease is uncompensated. Long term anticoagulation is mandatory when the cause is rheumatic heart disease. In other pathologies, though anticoagulation has not been shown to reduce mortality, it significantly reduces the number of cerebrovascular accidents, including in the elderly and with low-dose vitamin K antagonist drugs. The efficacy of anticoagulation in preventing arterial embolism has not been established. Reduction of atrial fibrillation is not essential if the arrhythmia is well tolerated, chronic, especially in elderly patients and when several recurrences have occurred despite preventive therapy. In other cases, medical reduction is to be preferred to cardioversion if the fibrillation is recent and well tolerated. Of the oral and injectable preparations, amiodarone seems to be the drug with best benefit/risk ratio. Prevention of recurrence of fibrillation is unnecessary for many after a first episode, especially when idiopathic. In other cases, there are many available drugs but results are uncertain except in those observed in atrial fibrillation related to the autonomic nervous system. Strictly controlled and statistically exploitable studies show comparable efficacy of quinine and other Class I drugs. Beta-blockers are not very useful and the excellent long term results with amiodarone require confirmation.(ABSTRACT TRUNCATED AT 250 WORDS)
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