Cardiac electrophysiology review
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Card Electrophysiol Rev · Jun 2003
ReviewPharmacological approach for the prevention of atrial fibrillation after cardiovascular surgery.
Atrial fibrillation (AF) is a common complication of cardiovascular surgery. The two most important risk factors for its development are advancing age and a preoperative history of AF. ⋯ These strategies are most effective in high-risk patients. When AF does occur, treatment includes control of the ventricular rate, systemic anticoagulation, and conversion to sinus rhythm.
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Card Electrophysiol Rev · Jun 2003
Review Randomized Controlled Trial Clinical TrialThe RACE study in perspective of randomized studies on management of persistent atrial fibrillation.
Atrial fibrillation is the most common sustained cardiac arrhythmia. Treatment strategies are focused on reducing symptoms and minimizing the risks of atrial fibrillation like stroke and heart failure. First choice therapy is the rhythm control strategy, with restoration of sinus rhythm. ⋯ It was observed from RACE that 21 of the 35 thromboembolic complications occurred under rhythm control, the majority while receiving inadequate anticoagulation therapy. Also in AFFIRM, with patients with one or more stroke risk factors, more strokes were present under rhythm control. Therefore, one of the main lesson learned from the randomized studies is that anticoagulation must be continued if stroke risk factors are present even if patients maintain sinus rhythm.
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Card Electrophysiol Rev · Jun 2003
ReviewIn the wake of the AFFIRM trial: what we still don't know about the management of atrial fibrillation and where we need to go.
Five recent trials have been completed comparing the strategy of rhythm control to the strategy of rate control for the management of atrial fibrillation. These trials have demonstrated no clear advantage for the rhythm control strategy using current pharmacologic therapies and that anticoagulation should not be discontinued in high-risk patients, even when it appears that sinus rhythm has been restored and maintained. Although a broad-based research approach is needed to advance our understanding of therapeutic options for the management of atrial fibrillation, the results of these five trials serve to focus the research enterprise on management of this common and often vexing tachyarrhythmia. ⋯ The role of nonpharmacologic therapies for maintenance of sinus rhythm needs more rigorous testing and we need better and safer drugs for this purpose. We need to understand better the relationships between atrial fibrillation and thromboembolism and we need alternatives to warfarin therapy. These and other research efforts are needed to make an impact on management of the problems of atrial fibrillation.