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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

Chronic atrial fibrillation: a systematic review of medical heart rate control management

T Nikolaidou1, K S Channer

  • 1Cardiology Department, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK. nikolaidou@btinternet.com

Postgraduate Medical Journal
|June 17, 2009
PubMed

Insights

Current guidelines suggest beta-blockers or calcium antagonists for chronic atrial fibrillation. However, this review indicates that combining digoxin with these agents may be a more effective first-line treatment for rate control.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Recent guidelines from NICE and ACC/AHA/ESC recommend beta-blockers or calcium antagonists as first-line treatment for chronic atrial fibrillation rate control.
  • Digoxin has been relegated to second-line treatment in these guidelines.

Purpose of the Study:

  • To assess the efficacy of digoxin, beta-blockers, and calcium antagonists in controlling heart rate.
  • To evaluate the impact of these drugs on symptoms and exercise tolerance in chronic atrial fibrillation.

Main Methods:

  • Systematic review of electronic databases (Medline, Embase, Cochrane) and manual searches.
  • Inclusion of 46 studies evaluating oral digoxin, beta-blockers, and calcium antagonists for rate control in chronic atrial fibrillation.

Main Results:

  • Studies were small and heterogeneous, precluding quantitative synthesis.
  • Monotherapy with beta-blockers or calcium antagonists showed limited evidence of improving symptoms or exercise capacity.
  • Monotherapy was associated with dose-related side effects.

Conclusions:

  • Limited data suggests that combining digoxin with either a beta-blocker or calcium antagonist should be considered first-line management.
  • This combination may offer superior rate control and symptom improvement in chronic atrial fibrillation.
Abstract

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