The Place of Antiarrhythmic Drugs and Rhythm Control in the Treatment of Atrial Fibrillation

2009 ◽  
Vol 5 (1) ◽  
pp. 36
Author(s):  
Philippe Chevalier ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Antiarrhythmic Drugs ◽  
Structural Heart Disease ◽  
Rhythm Control ◽  
Disease Course ◽  
Drug Trials ◽  
Cardiac Safety ◽  
Selection Of

Atrial fibrillation (AF) is the most common arrhythmia, with incidence increasing with age and a ranging severity of symptoms. The arrhythmia, perpetuated from electrical, functional and structural remodelling by AF itself, can ultimately lead to increased morbidity and mortality. Emerging evidence appears to support the initiation of rhythm control, particularly early on in the disease course. Antiarrhythmic drugs have proved useful in inducing and maintaining cardioversion, but treatment varies depending on the degree of structural heart disease. Drug trials and selection of therapy have historically focused largely on cardiac safety. Class Ic drugs have demonstrated safety and efficacy in patients with little to no structural heart disease, yet their use continues to be superseded by the use of other drugs, especially amiodarone, which carries significant risks of extracardiac effects and end-organ toxicities. This article discusses the role of sinus rhythm control and antiarrhythmic drugs in AF, with an emphasis on patients exhibiting no or minimal structural heart disease and the importance of selecting an appropriate antiarrhythmic drug, taking into account arrhythmia burden, presence of concurrent cardiovascular disease and severity and, most importantly, the safety of the drug therapy.

Role of Autonomic Tone in the Initiation and Termination of Paroxysmal Atrial Fibrillation in Patients Without Structural Heart Disease

2003 ◽  
Vol 14 (6) ◽  
pp. 559-564 ◽  
Author(s):  
Takeshi Tomita ◽  
Manabu Takei ◽  
Yuko Saikawa ◽  
Takeshi Hanaoka ◽  
Shin‐Ichiroh Uchikawa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Paroxysmal Atrial Fibrillation ◽  
Structural Heart Disease ◽  
Autonomic Tone

scholarly journals Flecainide in Ventricular Arrhythmias: From Old Myths to New Perspectives

2021 ◽  
Vol 10 (16) ◽  
pp. 3696
Author(s):  
Carlo Lavalle ◽  
Sara Trivigno ◽  
Giampaolo Vetta ◽  
Michele Magnocavallo ◽  
Marco Valerio Mariani ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Ventricular Arrhythmias ◽  
Heart Diseases ◽  
Structural Heart Disease ◽  
Rhythm Control ◽  
Current Evidence ◽  
Structural Heart Diseases ◽  
Therapeutic Tools ◽  
Sinus Rhythm Maintenance

Flecainide is an IC antiarrhythmic drug (AAD) that received in 1984 Food and Drug Administration approval for the treatment of sustained ventricular tachycardia (VT) and subsequently for rhythm control of atrial fibrillation (AF). Currently, flecainide is mainly employed for sinus rhythm maintenance in AF and the treatment of idiopathic ventricular arrhythmias (IVA) in absence of ischaemic and structural heart disease on the basis of CAST data. Recent studies enrolling patients with different structural heart diseases demonstrated good effectiveness and safety profile of flecainide. The purpose of this review is to assess current evidence for appropriate and safe use of flecainide, 30 years after CAST data, in the light of new diagnostic and therapeutic tools in the field of ischaemic and non-ischaemic heart disease.

scholarly journals Vernakalant in Atrial Fibrillation: A Relatively New Weapon in the Armamentarium Against an Old Enemy

2019 ◽  
Vol 13 ◽  
pp. 117739281986111 ◽  
Author(s):  
Antoine Kossaify
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Structural Heart Disease ◽  
Rhythm Control ◽  
Disease Class ◽  
Recent Onset ◽  
Comprehensive Management ◽  
Class Iib ◽  
Pharmacological Cardioversion ◽  
Onset Atrial Fibrillation

Atrial fibrillation is the most common sustained cardiac arrhythmia, and its prevalence is increasing with age; also it is associated with significant morbidity and mortality. Rhythm control is advised in recent-onset atrial fibrillation, and in highly symptomatic patients, also in young and active individuals. Moreover, rhythm control is associated with lower incidence of progression to permanent atrial fibrillation. Vernakalant is a relatively new anti-arrhythmic drug that showed efficacy and safety in recent-onset atrial fibrillation. Vernakalant is indicated in atrial fibrillation (⩽7 days) in patients with no heart disease (class I, level A) or in patients with mild or moderate structural heart disease (class IIb, level B). Moreover, Vernakalant may be considered for recent-onset atrial fibrillation (⩽3 days) post cardiac surgery (class IIb, level B). Although it is mainly indicated in patients with recent-onset atrial fibrillation and with no structural heart disease, it can be given in moderate stable cardiac disease as alternative to Amiodarone. Similarly to electrical cardioversion, pharmacological cardioversion requires a minimal evaluation and cardioversion should be included in a comprehensive management strategy for better outcome.

Utilisation of Robotic Navigation Systems in the Treatment of Atrial Fibrillation

2010 ◽  
Vol 6 (3) ◽  
pp. 60
Author(s):  
Richard Schilling ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Navigation System ◽  
Antiarrhythmic Drugs ◽  
Rhythm Control ◽  
Navigation Systems ◽  
Robotic Navigation ◽  
Increased Risk ◽  
Common Strategy ◽  
Catheter Navigation

Atrial fibrillation (AF) is linked to an increased risk of adverse cardiovascular events. While rhythm control with antiarrhythmic drugs (AADs) is a common strategy for managing patients with AF, catheter ablation may be a more efficacious and safer alternative to AADs for sinus rhythm control. Conventional catheter ablation has been associated with challenges during the arrhythmia mapping and ablation stages; however, the introduction of two remote catheter navigation systems (a robotic and a magnetic navigation system) may potentially overcome these challenges. Initial clinical experience with the robotic navigation system suggests that it offers similar procedural times, efficacy and safety to conventional manual ablation. Furthermore, it has been associated with reduced fluoroscopy exposure to the patient and the operator as well as a shorter fluoroscopy time compared with conventional catheter ablation. In the future, the remote navigation systems may become routinely used for complex catheter ablation procedures.

Advanced interatrial block precedes atrial fibrillation and stroke. The prospective interatrial Block And Yearly EventS (BAYES) registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Martinez-Selles ◽  
R Elosua ◽  
M Ibarrola ◽  
M De Andres ◽  
P Diez-Villanueva ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Sinus Rhythm ◽  
Structural Heart Disease ◽  
P Wave ◽  
Wave Duration ◽  
P Wave Duration ◽  
Previous Diagnosis ◽  
Surface Ecg ◽  
Interatrial Block

Abstract Background Advanced interatrial block (IAB), prolonged and bimodal P waves in surface ECG inferior leads, is an unrecognized surrogate of atrial dysfunction and a trigger of atrial dysrhythmias, mainly atrial fibrillation (AF). Our aim was to prospectively assess whether advanced IAB in sinus rhythm precedes AF and stroke in elderly outpatients with structural heart disease, a group not previously studied. Methods Prospective observational registry that included outpatients aged ≥70 years with structural heart disease and no previous diagnosis of AF. Patients were divided into three groups according to P-wave characteristics. Results Among 556 individuals, 223 had normal P-wave (40.1%), 196 partial IAB (35.3%), and 137 advanced IAB (24.6%). After a median follow-up of 694 days; 93 patients (16.7%) developed AF, 30 stroke (5.4%), and 34 died (6.1%). Advanced IAB was independently associated with AF (hazard ratio [HR] 2.9, 95% confidence interval [CI] 1.7–5.1, p<0.001), stroke (HR 3.8, 95% CI 1.4–10.7, p=0.010), and AF/stroke (HR 2.6, 95% CI 1.5–4.4, p=0.001). P-wave duration (ms) was independently associated with AF (HR 1.05, 95% CI 1.03–1.07, p<0.001), AF/stroke (HR 1.04, 95% CI 1.02–1.06, p<0.001), and mortality (HR 1.04, 95% CI 1.00–1.08, p=0.021). Conclusions The presence of advanced IAB in sinus rhythm is a risk factor for AF and stroke in an elderly population with structural heart disease and no previous diagnosis of AF. P-wave duration was also associated with all-cause mortality. Figure. Age- and sex-adjusted linear and non-linear association between P-wave duration (msec) and atrial fibrillation (A), stroke (B), and atrial fibrillation or stroke (C) risk. Results of a generalized additive model with spline smoothing functions and 4 degrees of freedom. Figure 1. Kaplan-Meyer curves of survival free of atrial fibrillation (A), stroke (B) and atrial fibrillation or stroke (C) in patients with normal P-wave, partial interatrial block (IAB) and advanced IAB. Funding Acknowledgement Type of funding source: None

scholarly journals Electropathological Substrate of Long-Standing Persistent Atrial Fibrillation in Patients With Structural Heart Disease

2010 ◽  
Vol 3 (6) ◽  
pp. 606-615 ◽  
Author(s):  
Maurits A. Allessie ◽  
Natasja M.S. de Groot ◽  
Richard P.M. Houben ◽  
Ulrich Schotten ◽  
Eric Boersma ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Structural Heart Disease ◽  
Persistent Atrial Fibrillation
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