Abstract
Antiarrhythmic drugs are an essential tool in the management of atrial fibrillation (AF). Although we are already on the threshold of a large expansion in the use of ablation therapies, these will not, however, be appropriate for all patients, and pharmacological therapies will continue to have an important place in the management of atrial fibrillation. The plethora of antiarrhythmic drugs currently available for the treatment of atrial fibrillation is a reflection that none is wholly satisfactory, each having limited efficacy combined with poor safety and tolerability. Improved class III antiarrhythmic drugs, such as dronedarone, new classes of antiarrhythmic agents, such as atrial repolarization delaying agents, and upstream therapies dealing with substrate, represent potential sources of new pharmacological therapies. Copyright © 2008 Wiley Periodicals, Inc.
Keywords: atrial fibrillation
Full Text
The Full Text of this article is available as a PDF (381.9 KB).
References
- 1. Camm AJ, Savelieva I, Lip GY: Rate control in the medical management of atrial fibrillation. Heart 2007; 93: 35–38. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Corley SD, Epstein AE, DiMarco JP, Domanski MJ, Geller N, et al, for the AFFIRM Investigators : Relationships between sinus rhythm, treatment, and survival in the Atrial Fibrillation Follow‐Up Investigation of Rhythm Management (AFFIRM) Study. Circulation 2004; 109: 1509–1513. [DOI] [PubMed] [Google Scholar]
- 3. Camm AJ, Savelieva I: Advances in antiarrhythmic drug treatment of atrial fibrillation: where do we stand now? Heart Rhythm 2004; 1: 244–246. [DOI] [PubMed] [Google Scholar]
- 4. Stiell IG, Roy D, Rowe BH, Pratt C, Dickinson G, et al.: Efficacy and safety of RSD1235 in the treatment of acute atrial fibrillation. Acad Emerg Med 2006; 13(suppl 1): 162. [Google Scholar]
- 5. Wegener FT, Ehrlich JR, Hohnloser SH: Dronedarone: an emerging agent with rhythm‐ and rate‐controlling effects. J Cardiovasc Electrophysiol 2006; 17(suppl 2): S17–S20. [DOI] [PubMed] [Google Scholar]
- 6. Gautier P, Serre M, Cosnier‐Pucheu S, Djandjighian L, Roccon A, et al.: In vivo and in vitro antiarrhythmic effects of SSR149744C in animal models of atrial fibrillation and ventricular arrhythmias. J Cardiovasc Pharmacol 2005; 45: 125–135. [DOI] [PubMed] [Google Scholar]
- 7. Lombardi F, Borggrefe M, Ruzyllo W, Luderitz B, for A‐COMET‐II Investigators : Azimilide vs placebo and sotalol for persistent atrial fibrillation: the A‐COMET‐II (Azimilide‐CardiOversion MaintEnance Trial‐II) trial. Eur Heart J 2006; 27: 2224–2231. [DOI] [PubMed] [Google Scholar]
- 8. Pritchett EL, Kowey P, Connolly S, Page RL, Kerr C, et al.: for A‐COMET‐I Investigators : Antiarrhythmic efficacy of azimilide in patients with atrial fibrillation: Maintenance of sinus rhythm after conversion to sinus rhythm. Am Heart J 2006; 151: 1043–1049. [DOI] [PubMed] [Google Scholar]
- 9. Madrid AH, Peng J, Zamora J, Marin I, Bernal E, et al.: The role of angiotensin receptor blockers and/or angiotensin converting enzyme inhibitors in the prevention of atrial fibrillation in patients with cardiovascular diseases: meta‐analysis of randomized controlled clinical trials. Pacing Clin Electrophysiol 2004; 27: 1405–1410. [DOI] [PubMed] [Google Scholar]
- 10. Healey JS, Baranchuk A, Crystal E, Morillo CA, Garfinkle M, et al.: Prevention of atrial fibrillation with angiotensin‐converting enzyme inhibitors and angiotensin receptor blockers: a meta‐analysis. J Am Coll Cardiol 2005; 45: 1832–1839. [DOI] [PubMed] [Google Scholar]
- 11. Jibrini MB, Arora R, Molnar J: Prevention of atrial fibrillation via abrogation of the renin‐angiotensin system: a pooled meta‐analysis of randomized controlled clinical trials. (Abstr). J Am Coll Cardiol 2006; 47: 9A.16386658 [Google Scholar]
- 12. Shiroshita‐Takeshita A, Schram G, Lavoie J, Nattel S: Effect of simvastatin and antioxidant vitamins on atrial fibrillation promotion by atrial‐tachycardia remodeling in dogs. Circulation 2004; 110: 2313–2319. [DOI] [PubMed] [Google Scholar]
- 13. Hanna IR, Heeke B, Bush H, Brosius L, King‐Hageman D, et al.: Lipid‐lowering drug use is associated with reduced prevalence of atrial fibrillation in patients with left ventricular systolic dysfunction. Heart Rhythm 2006; 3: 881–886. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14. Patti G, Chello M, Candura D, Pasceri V, D'Ambrosio A, et al.: Randomized trial of atorvastatin for reduction of postoperative atrial fibrillation in patients undergoing cardiac surgery: results of the ARMYDA‐3 (Atorvastatin for Reduction of MYocardial Dysrhythmia After cardiac surgery) study. Circulation 2006; 114: 1455–1461. [DOI] [PubMed] [Google Scholar]
- 15. Mozaffarian D, Psaty BM, Rimm EB, Lemaitre RN, Burke GL, et al.: Fish intake and risk of incident atrial fibrillation. Circulation 2004; 110: 368–373. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16. Frost L, Vestergaard P: n‐3 Fatty acids consumed from fish and risk of atrial fibrillation or flutter: the Danish Diet, Cancer, and Health Study. Am J Clin Nutr 2005; 81: 50–54. [DOI] [PubMed] [Google Scholar]
- 16a. Brower IA, Heeringa J, Celeijnse JM, Zock PL, et al.: Intake of very long‐chain n‐3 fatty acids from fish and incidence of atrial fibrillation. The Rotterdam study. Am Heart J 2006; 151: 857–862. [DOI] [PubMed] [Google Scholar]
- 17. Wazni OM, Marrouche NF, Martin DO, Verma A, Bhargava M, et al.: Radiofrequency ablation vs antiarrhythmic drugs as first‐line treatment of symptomatic atrial fibrillation: a randomized trial. JAMA 2005; 293: 2634–2640. [DOI] [PubMed] [Google Scholar]
- 18. Stabile G, Bertaglia E, Senatore G, De Simone A, Zoppo F, et al.: Catheter ablation treatment in patients with drug‐refractory atrial fibrillation: a prospective, multi‐centre, randomized, controlled study (Catheter Ablation for the Cure of Atrial Fibrillation study). Eur Heart J 2006; 27: 216–221. [DOI] [PubMed] [Google Scholar]
- 19. Oral H, Pappone C, Chugh A, et al.: Circumferential pulmonary‐vein ablation for chronic atrial fibrillation. N Engl J Med 2006; 354: 934–941. [DOI] [PubMed] [Google Scholar]
- 20. Pappone C, Augello G, Sala S, Gugliotta F, Vicedomini G, et al.: A randomized trial of circumferential pulmonary vein ablation versus antiarrhythmic drug therapy in paroxysmal atrial fibrillation: the APAF Study. J Am Coll Cardiol 2006; 48: 2340–2347. [DOI] [PubMed] [Google Scholar]
- 21. Hsu LF, Jais P, Sanders P, Rotter M, Takahashi Y, et al.: Catheter ablation for atrial fibrillation in congestive heart failure. N Engl J Med 2004; 351: 2373–2383. [DOI] [PubMed] [Google Scholar]
- 22. Lickfett L, Hackenbroch M, Lewalter T, Selbach S, Schwab JO, et al.: Cerebral diffusion‐weighted magnetic resonance imaging: a tool to monitor the thrombogenicity of left atrial catheter ablation. J Cardiovasc Electrophysiol 2006; 17: 1–7. [DOI] [PubMed] [Google Scholar]
- 23. Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, et al.: Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation 2005; 111: 1100–1105. [DOI] [PubMed] [Google Scholar]
- 24. Jahangiri M, Weir G, Mandal K, Savelieva I, Camm J: Current strategies in the management of atrial fibrillation. Ann Thorac Surg 2006; 82: 357–364. [DOI] [PubMed] [Google Scholar]
- 25. Reston JT, Shuhaiber JH: Meta‐analysis of clinical outcomes of maze‐related surgical procedures for medically refractory atrial fibrillation. Eur J Cardiothorac Surg 2005; 28: 724–730. [DOI] [PubMed] [Google Scholar]
- 26. Savelieva I, Camm AJ: The results of pacing trials for the prevention and termination of atrial tachyarrhythmias: is there any evidence of therapeutic breakthrough? J Interv Card Electrophysiol 2003; 8: 103–115. [DOI] [PubMed] [Google Scholar]