Abstract
Despite the availability of potentially curative interventions for atrial fibrillation, there remains an important role for conventional anti-arrhythmic therapy and anti-coagulation combined with direct current cardioversion. Unfortunately, the latter approach is disturbed by high recurrence rates of atrial fibrillation. In recent years, several adjunctive therapies have emerged which may facilitate the maintenance of sinus rhythm. These novel therapies and their potential mechanisms of action are reviewed in this article.
Highlights
Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia found in clinical practice [1, 2]
A number of large randomised trials have investigated the merits of a rate versus rhythm control strategy: Pharmacological Intervention in Atrial Fibrillation (PIAF), Strategies of Treatment of Atrial Fibrillation (STAF), Rate Control Versus Electrical Conversion (RACE), Atrial Fibrillation Followup of Rhythm Management (AFFIRM), and How to Treat Chronic Atrial Fibrillation (HOT-CAFE) [6,7,8,9,10]
None of these studies were able to demonstrate a significant advantage of either strategy with respect to cardiovascular morbidity and mortality, whereas they all revealed an increase in hospitalisation associated with rhythm control, PIAF and AFFIRM demonstrating a significantly higher incidence of adverse drug events amongst the rhythm control groups
Summary
Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia found in clinical practice [1, 2]. A number of large randomised trials have investigated the merits of a rate versus rhythm control strategy: Pharmacological Intervention in Atrial Fibrillation (PIAF), Strategies of Treatment of Atrial Fibrillation (STAF), Rate Control Versus Electrical Conversion (RACE), Atrial Fibrillation Followup of Rhythm Management (AFFIRM), and How to Treat Chronic Atrial Fibrillation (HOT-CAFE) [6,7,8,9,10] None of these studies were able to demonstrate a significant advantage of either strategy with respect to cardiovascular morbidity and mortality, whereas they all revealed an increase in hospitalisation associated with rhythm control, PIAF and AFFIRM demonstrating a significantly higher incidence of adverse drug events amongst the rhythm control groups. This review examines the growing body of evidence that suggests that targeting the rennin angiotensin aldosterone system (RAS), reducing inflammation, and using drugs such as statins and fatty acids may offer a legitimate approach to the prevention of AF recurrence
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
