Pharmacotherapy for atrial fibrillation: is rhythm control achievable?

Abstract

As the most common sustained cardiac arrhythmia, the health burden presented by atrial fibrillation (AF) continues to grow. One of the current dilemmas in managing AF lies in the decision of whether to pursue a rate or rhythm control strategy. Current antiarrhythmic drugs have many limitations in terms of efficacy and adverse effects, and the availability of better antiarrhythmic drugs that are effective and safe would probably improve outcomes in AF. Enthusiasm for pulmonary vein ablation procedures has been tempered by the relatively high frequency of recurrences of AF, which are often asymptomatic. Ablation also frequently converts symptomatic episodes to asymptomatic recurrences. Irrespective of whether a rate control or a rhythm control strategy is adopted in patients with persistent AF, appropriate antithrombotic therapy should be used.

Keywords::

• antiarrhythmic drugs
• atrial fibrillation
• rate control
• rhythm control

Acknowledgements

GYH Lip has received funding for research, educational symposia, consultancy and lecturing from different manufacturers of drugs used for the treatment of AF and thrombosis. He is Clinical Adviser to the Guideline Development Group writing the United Kingdom NICE guidelines on AF management [101].

Notes

AF: Atrial fibrillation.