scholarly journals Current Drug Treatment Strategies for Atrial Fibrillation and TASK-1 Inhibition as an Emerging Novel Therapy Option

2021 ◽  
Vol 12 ◽  
Author(s):  
Manuel Kraft ◽  
Antonius Büscher ◽  
Felix Wiedmann ◽  
Yannick L’hoste ◽  
Walter E. Haefeli ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Rate Control ◽  
Antiarrhythmic Drugs ◽  
Heart Diseases ◽  
Pulmonary Veins ◽  
Treatment Strategies ◽  
Rhythm Control ◽  
Electrical Cardioversion ◽  
Adequate Treatment

Atrial fibrillation (AF) is the most common sustained arrhythmia with a prevalence of up to 4% and an upwards trend due to demographic changes. It is associated with an increase in mortality and stroke incidences. While stroke risk can be significantly reduced through anticoagulant therapy, adequate treatment of other AF related symptoms remains an unmet medical need in many cases. Two main treatment strategies are available: rate control that modulates ventricular heart rate and prevents tachymyopathy as well as rhythm control that aims to restore and sustain sinus rhythm. Rate control can be achieved through drugs or ablation of the atrioventricular node, rendering the patient pacemaker-dependent. For rhythm control electrical cardioversion and pharmacological cardioversion can be used. While electrical cardioversion requires fasting and sedation of the patient, antiarrhythmic drugs have other limitations. Most antiarrhythmic drugs carry a risk for pro-arrhythmic effects and are contraindicated in patients with structural heart diseases. Furthermore, catheter ablation of pulmonary veins can be performed with its risk of intraprocedural complications and varying success. In recent years TASK-1 has been introduced as a new target for AF therapy. Upregulation of TASK-1 in AF patients contributes to prolongation of the action potential duration. In a porcine model of AF, TASK-1 inhibition by gene therapy or pharmacological compounds induced cardioversion to sinus rhythm. The DOxapram Conversion TO Sinus rhythm (DOCTOS)-Trial will reveal whether doxapram, a potent TASK-1 inhibitor, can be used for acute cardioversion of persistent and paroxysmal AF in patients, potentially leading to a new treatment option for AF.

scholarly journals Rhythm-control vs rate-control in the elderly: When to do it and which drug to prefer?

2018 ◽  
Vol 88 (2) ◽  
Author(s):  
Giovanni Luca Botto ◽  
Carlo Piemontese ◽  
Giovanni Russo
Keyword(s):  
Atrial Fibrillation ◽  
Elderly Patient ◽  
Rate Control ◽  
Ischemic Cardiomyopathy ◽  
Elderly Population ◽  
Antiarrhythmic Drugs ◽  
Treatment Options ◽  
The Elderly ◽  
Rhythm Control ◽  
Abnormal Rate

Atrial fibrillation (AF) is a relevant cardiovascular condition that is more prevalent in the elderly patients aged over 65 years. AF, with abnormal rate and rhythm can cause symptoms directly or indirectly by exacerbating other frequently coexisting cardiac conditions such as valvular heart disease, hypertension, ischemic cardiomyopathy, dilated cardiomyopathy, and hypertrophic cardiomyopathy. Evidence suggests that aging-related cardiovascular changes predispose to the elderly to AF. Current therapeutic options such as antiarrhythmic drugs have not been extensively evaluated in the elderly population. Emerging pharmacological and non-pharmacological treatment options for the management of AF, such as dronedarone or catheter ablation, are of particular interest in the elderly. The present paper reviews the pathophysiology, diagnosis, and the management of AF in the elderly patient.

scholarly journals Recent advances in rhythm control for atrial fibrillation

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 1796 ◽  
Author(s):  
Richard Bond ◽  
Brian Olshansky ◽  
Paulus Kirchhof
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Rate Control ◽  
Rhythm Control ◽  
Management Problem ◽  
Recent Trial ◽  
Control Therapy

Atrial fibrillation (AF) remains a difficult management problem. The restoration and maintenance of sinus rhythm—rhythm control therapy—can markedly improve symptoms and haemodynamics for patients who have paroxysmal or persistent AF, but some patients fare well with rate control alone. Sinus rhythm can be achieved with anti-arrhythmic drugs or electrical cardioversion, but the maintenance of sinus rhythm without recurrence is more challenging. Catheter ablation of the AF triggers is more effective than anti-arrhythmic drugs at maintaining sinus rhythm. Whilst pulmonary vein isolation is an effective strategy, other ablation targets are being evaluated to improve sinus rhythm maintenance, especially in patients with chronic forms of AF. Previously extensive ablation strategies have been used for patients with persistent AF, but a recent trial has shown that pulmonary vein isolation without additional ablation lesions is associated with outcomes similar to those of more extensive ablation. This has led to an increase in catheter-based technology to achieve durable pulmonary vein isolation. Furthermore, a combination of anti-arrhythmic drugs and catheter ablation seems useful to improve the effectiveness of rhythm control therapy. Two large ongoing trials evaluate whether a modern rhythm control therapy can improve prognosis in patients with AF.

Do Restoring and Maintaining Sinus Rhythm Have a Beneficial Effect on Secondary Prevention of Stroke in Patients With Atrial Fibrillation? A Pilot Study

Angiology ◽  
2019 ◽  
Vol 70 (10) ◽  
pp. 916-920 ◽  
Author(s):  
Cenk Conkbayir ◽  
Zerrin Yigit ◽  
Refika Hural ◽  
Murat Ugurlucan ◽  
Didem Melis Oztas ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Secondary Prevention ◽  
Sinus Rhythm ◽  
Beneficial Effect ◽  
Rate Control ◽  
Recurrent Stroke ◽  
Rhythm Control ◽  
Control Group ◽  
Echocardiographic Examination ◽  
Ischemic Attack

We aimed to determine whether attempts to restore and maintain sinus rhythm will reduce recurrent stroke in patients with atrial fibrillation (AF). Patients (n = 245) between March 1998 and May 2002 with AF who had an ischemic stroke including transient ischemic attack 1 to 12 months before transesophageal echocardiographic examination and had been followed for 3 years were retrospectively reviewed. Cardioversion was attempted in 130 patients; 117 (90%) patients were successfully cardioverted (rhythm control group). The 13 patients who could not be cardioverted and 115 patients who did not undergo cardioversion were assigned to the rate control group. Age, gender, ischemic heart disease, hypertension, diabetes mellitus, congestive heart failure, mitral valve disease, and left atrial diameter were similar in both groups. The rhythm control group included 56 patients (48.7%) who were still in sinus rhythm after 3 years. During follow-up, there were 2 embolic events (3.4%) and 2 deaths (3.4%) in the rhythm control group, whereas 18 embolic events (14.6%) and 18 deaths (14.6%) occurred in the rate control group ( P = .049 and P = .049, respectively). Restoration and maintenance of sinus rhythm seems to have a beneficial effect on secondary prevention of stroke in patients with AF.

Rate versus rhythm control therapy for atrial fibrillation

2018 ◽  
Author(s):  
Albert L. Waldo
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Control Strategy ◽  
Rate Control ◽  
Anticoagulation Therapy ◽  
Rhythm Control ◽  
Rate Versus ◽  
Ventricular Response ◽  
Tachycardia Induced Cardiomyopathy ◽  
Stable Sinus Rhythm

Based on data from several clinical trials, either rate control or rhythm control is an acceptable primary therapeutic strategy for patients with atrial fibrillation. However, since atrial fibrillation tends to recur no matter the therapy, rate control should almost always be a part of the treatment. If a rhythm control strategy is selected, it is important to recognize that recurrence of atrial fibrillation is common, but not clinical failure per se. Rather, the frequency and duration of episodes, as well as severity of symptoms during atrial fibrillation episodes should guide treatment decisions. Thus, occasional recurrence of atrial fibrillation despite therapy may well be clinically acceptable. However, for some patients, rhythm control may be the only strategy that is acceptable. In short, for most patients, either a rate or rhythm control strategy should be considered. However, for all patients, there are two main goals of therapy. One is to avoid stroke and/or systemic embolism, and the other is to avoid a tachycardia-induced cardiomyopathy. Also, because of the frequency of atrial fibrillation recurrence despite the treatment strategy selected, patients with stroke risks should receive anticoagulation therapy despite seemingly having achieved stable sinus rhythm. For patients in whom a rate control strategy is selected, a lenient approach to the acceptable ventricular response rate is a resting heart rate of 110 bpm, and probably 90 bpm. The importance of achieving and maintaining sinus rhythm in patients with atrial fibrillation and heart failure remains to be clearly established.

Rate versus rhythm control therapy for atrial fibrillation

ESC CardioMed ◽  
2018 ◽  
pp. 2177-2180
Author(s):  
Albert L. Waldo
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Control Strategy ◽  
Rate Control ◽  
Anticoagulation Therapy ◽  
Rhythm Control ◽  
Rate Versus ◽  
Ventricular Response ◽  
Tachycardia Induced Cardiomyopathy ◽  
Stable Sinus Rhythm

Based on data from several clinical trials, either rate control or rhythm control is an acceptable primary therapeutic strategy for patients with atrial fibrillation. However, since atrial fibrillation tends to recur no matter the therapy, rate control should almost always be a part of the treatment. If a rhythm control strategy is selected, it is important to recognize that recurrence of atrial fibrillation is common, but not clinical failure per se. Rather, the frequency and duration of episodes, as well as severity of symptoms during atrial fibrillation episodes should guide treatment decisions. Thus, occasional recurrence of atrial fibrillation despite therapy may well be clinically acceptable. However, for some patients, rhythm control may be the only strategy that is acceptable. In short, for most patients, either a rate or rhythm control strategy should be considered. However, for all patients, there are two main goals of therapy. One is to avoid stroke and/or systemic embolism, and the other is to avoid a tachycardia-induced cardiomyopathy. Also, because of the frequency of atrial fibrillation recurrence despite the treatment strategy selected, patients with stroke risks should receive anticoagulation therapy despite seemingly having achieved stable sinus rhythm. For patients in whom a rate control strategy is selected, a lenient approach to the acceptable ventricular response rate is a resting heart rate of 110 bpm or less, and probably 90 bpm or less. The importance of achieving and maintaining sinus rhythm in patients with atrial fibrillation and heart failure remains to be clearly established.

Treatment of Acute Atrial Fibrillation: Ventricular Rate Control and Restoration of Sinus Rhythm

2000 ◽  
Vol 7 (2) ◽  
pp. 85-95
Author(s):  
Ht Fung ◽  
Cw Kam
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Cardiac Output ◽  
General Population ◽  
Sinus Rhythm ◽  
Rate Control ◽  
Electrical Cardioversion ◽  
Ventricular Rate ◽  
The Past ◽  
Definite Risk

Atrial fibrillation (AF) is a familiar arrhythmia seen in the emergency department and the general population. In the past it was treated in the majority of cases by controlling the ventricular rate, whether the AF is acute or chronic. However, ventricular rate control alone does not address the underlying problem and the patients still remain in AF, cardiac output and symptoms have not been optimally corrected. There is definite risk of thromboembolism. Restoration of sinus rhythm is the only way of resuming the normal conduction physiology of the heart and correcting these problems This article provides a review of the two major principles of rhythm treatment of acute AF: rate control and restoration of sinus rhythm. Transthoracic electrical cardioversion is the mainstay of treatment in haemodynamically unstable AF, whereas in stable AF, there is a choice between rate control and restoration of sinus rhythm, or they can be carried out in conjunction with each other.

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