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Acute treatment of atrial fibrillation
P R Kowey1, R A Marinchak, S J Rials
1Department of Medicine, Lankenau Hospital and Medical Research Center, Wynnewood, Pennsylvania, USA.
Insights
Acute treatment for atrial fibrillation (AFib) offers immediate symptom relief and may be more cost-effective than long-term therapies. This approach aims to control heart rate, prevent clots, and restore normal rhythm quickly.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Atrial fibrillation (AFib) is a prevalent arrhythmia causing significant morbidity, mortality, and healthcare costs.
- Traditional AFib management focused on long-term antithrombotic and antiarrhythmic drug therapy.
- Growing interest exists in acute treatment strategies for AFib.
Purpose of the Study:
- To summarize current and emerging acute treatment modalities for atrial fibrillation.
- To highlight the benefits of acute AFib management, including symptom relief and cost-effectiveness.
- To discuss strategies for controlling ventricular response, preventing thromboembolism, and achieving acute rhythm conversion.
Main Methods:
- Review of available and developing treatments for acute AFib management.
- Focus on pharmacologic and electrical cardioversion strategies.
- Discussion of methods to control ventricular rate and prevent thromboembolic events.
Main Results:
- Acute conversion of AFib offers immediate symptom alleviation.
- Avoidance of long-term antithrombotic therapy is a key benefit.
- Acute treatment may prevent hospital admission and reduce long-term healthcare costs.
- Acute interventions can prevent detrimental electrophysiologic remodeling.
Conclusions:
- Active, acute treatment of AFib and atrial flutter is likely to become standard practice.
- Benefits include symptom control, reduced mortality, and cost-effectiveness.
- Further clinical trials are expected to support the widespread adoption of acute AFib management.
Abstract:
Atrial fibrillation (AFib) is a common clinical entity, responsible for significant morbidity and mortality, but it also accounts for a large percentage of healthcare dollar expenditures. Efforts to treat this arrhythmia in the past have focused on subacute antithrombotic therapy and eventually use of antiarrhythmic drugs for maintenance of sinus rhythm. However, there has been a growing interest in the concept of acute electrical and pharmacologic conversion. This treatment strategy has a number of benefits, including immediate alleviation of patient symptoms, avoidance of antithrombotic therapy, and prevention of electrophysiologic remodeling, which is thought to contribute to the perpetuation of the arrhythmia. There is also increasing evidence that this is a cost-effective strategy in that it may obviate admission to the hospital and the cost of long-term therapy. This article represents a summary of the treatments that may be used acutely to control the ventricular response to AFib, prevent thromboembolic events, and provide for acute conversion either pharmacologically or electrically. It includes information on modalities that are currently available and those that are under active development. We anticipate that an active, acute treatment approach to AFib and atrial flutter will become the therapeutic norm in the next few years, especially as the benefits of these interventions are demonstrated in clinical trials.