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 TrialIntravenous versus oral beta-blockers for prevention of post-CABG atrial fibrillation in high-risk patients identified by signal-averaged ECG: lessons of a pilot study.
Atrial fibrillation (AF) is the most common complication of coronary artery bypass grafting (CABG), usually occurring on the second or third post-operative day. Post-operative AF is associated with prolonged hospital stay and increased costs. In several randomized trials, prophylactic oral beta-blocker reduced the incidence of post-operative AF. ⋯ In the esmolol group, 11 (41%) patients developed adverse effects, mostly hypotension, compared to only one patient (4%) in the oral beta-blocker group (p = 0.006). The result of this pilot study showed that intravenous esmolol compared to oral beta-blocker offers no advantage in preventing post-operative AF and is associated with increased adverse events. Thus, all patients without contraindication should receive oral beta-blocker before and after cardiac surgery to prevent post-operative AF.
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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.