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[The treatment of chronic atrial fibrillation]
1Afdeling Cardiologie, Acadamisch Ziekenhuis Groningen.
Insights
Chronic atrial fibrillation management focuses on restoring sinus rhythm via electrical cardioversion. Anti-arrhythmic drugs have risks, making rate control and antithrombotic therapy crucial considerations for preventing thromboembolism.
Area of Science:
- Cardiology
- Electrophysiology
Context:
- Atrial fibrillation is a prevalent arrhythmia linked to significant morbidity and mortality.
- Thromboembolism is a major complication of atrial fibrillation.
Purpose:
- To discuss management strategies for chronic atrial fibrillation.
- To evaluate methods for restoring sinus rhythm and controlling ventricular rate.
Summary:
- Electrical cardioversion is the preferred method for restoring sinus rhythm in chronic atrial fibrillation.
- Anti-arrhythmic drugs carry risks, including proarrhythmia, necessitating careful consideration of their benefits and drawbacks.
- Optimizing ventricular rate control pharmacologically is an alternative strategy, but antithrombotic therapy remains essential for thromboembolism prevention.
Impact:
- Improved exercise tolerance and symptom alleviation may result from restoring sinus rhythm.
- Risk stratification for antithrombotic therapy is critical in atrial fibrillation management.
- Balancing the risks and benefits of anti-arrhythmic drugs versus rate control strategies is key.
Abstract:
Atrial fibrillation is a common arrhythmia. It is associated with increased morbidity and mortality, in part secondary to an increased rate of thromboembolism. Considering the arrhythmia's duration, a chronic and paroxysmal type can be recognized. Only the former will be discussed here. Treatment of atrial fibrillation should be aimed at restoring sinus rhythm. This may improve exercise tolerance and alleviate symptoms. In addition, it may obviate the need for antithrombotic therapy. Electrical cardioversion is the method of choice to restore sinus rhythm in patients with chronic atrial fibrillation. To prevent arrhythmia relapses, anti-arrhythmic drugs are often prescribed. These drugs, however, may have serious side effects, e.g. proarrhythmia. The pros and cons of antiarrhythmics should therefore be considered seriously before prescribing these drugs. An alternative strategy is to optimize ventricular rate response (usually pharmacologically) while the patient maintains in atrial fibrillation. To prevent thromboembolism, however, the use of antithrombotic is strongly recommended in most of these patients.