[Drug therapy of atrial fibrillation]

Atrial fibrillation can, clinically, be differentiated into several subgroups. Paroxysmal atrial fibrillation lasts less than 24 hours and is often caused by an autonomic dysregulation. Chronic atrial fibrillation occurs in a reversible and an irreversible form. Atrial fibrillation is frequently observed transiently after cardiac surgery. The therapeutic goal must be clearly defined before treatment is initiated. In patients with a reversible form of chronic atrial fibrillation, sinus rhythm can be restored with class Ia, Ic and III antiarrhythmic drugs. These patients with sinus rhythm benefit from higher cardiac output, fewer thromboembolic complications and fewer symptoms (no palpitations). In patients suffering from an irreversible form of chronic atrial fibrillation the therapeutic aim is control of ventricular rate. Digoxin, beta-blockers (class II) and calcium antagonists (class IV) are successfully used to slow atrioventricular conduction. Patients aged over 65 years should be anticoagulated, since numerous studies have shown a marked decrease in thromboembolic complications with warfarin.