Rhythm management in atrial fibrillation--with a primary emphasis on pharmacological therapy: Part 1

Pacing Clin Electrophysiol. 1998 Mar;21(3):590-602. doi: 10.1111/j.1540-8159.1998.tb00103.x.

Abstract

Atrial fibrillation (AF) is the most common, sustained, symptomatic tachyarrhythmia that clinicians are called upon to manage. Management strategies include ventricular rate control coupled with anticoagulation, versus restoration and maintenance of sinus rhythm. Rate control may be achieved pharmacologically, with agents that impair AV nodal conduction directly and/or by increasing parasympathetic/sympathetic balance, or by modifying or ablating the AV nodal region anatomically. Rhythm control may be achieved by electrical or pharmacological conversion followed by maintenance of sinus rhythm by pharmacological (or occasionally ablative) therapies. This article will present current approaches to rate and rhythm control issues in AF. Part 1, the current manuscript, details approaches to rate control and includes a drug selection algorithmic conclusion. It also introduces the subject of the pursuit of sinus rhythm. Parts 2 and 3, to be published in subsequent editions of PACE, will deal with therapeutic measures to restore and maintain sinus rhythm.

Publication types

  • Review

MeSH terms

  • Anti-Arrhythmia Agents / therapeutic use*
  • Atrial Fibrillation / drug therapy*
  • Atrial Fibrillation / physiopathology
  • Atrioventricular Node / drug effects
  • Drug Therapy, Combination
  • Electrocardiography
  • Heart Rate / drug effects*
  • Humans
  • Recurrence
  • Treatment Outcome

Substances

  • Anti-Arrhythmia Agents