Abstract
atrial fibrillation (AF) is associated with a significant burden of morbidity and increased risk of mortality. Antiarrhythmic drug therapy remains a cornerstone to restore and maintain sinus rhythm for patients with paroxysmal and persistent AF based on current guidelines. However, conventional drugs have limited efficacy, present problematic risks of proarrhythmia and cause significant noncardiac organ toxicity. Thus, inadequacies in current therapies for atrial fibrillation have made new drug development crucial. New antiarrhythmic drugs and new anticoagulant agents have changed the current management of AF. This paper summarizes the available evidence regarding the efficacy of medications used for acute management of AF, rhythm and ventricular rate control, and stroke prevention in patients with atrial fibrillation and focuses on the current pharmacological agents.
Highlights
Atrial fibrillation (AF) is the most common cardiac rhythm disturbance seen in clinical practice accounting for approximately one-third of hospitalizations [1]
This paper summarizes the available evidence regarding the efficacy of medications used for acute management of AF, rhythm and ventricular rate control, and stroke prevention in patients with atrial fibrillation and focuses on the current pharmacological agents
This paper summarizes the available evidence regarding the efficacy of medications used for ventricular rate control, Cardiology Research and Practice
Summary
Atrial fibrillation (AF) is the most common cardiac rhythm disturbance seen in clinical practice accounting for approximately one-third of hospitalizations [1]. Management of patients with AF requires knowledge of its pattern of presentation [6] (first diagnosed, paroxysmal, persistent, long-standing, and permanent AF, Figure 1), underlying conditions, and decisions about restoration and maintenance of sinus rhythm, control of the ventricular rate, and antithrombotic therapy. Prevention of AF-related complications relies on antithrombotic therapy, control of ventricular rate, and adequate therapy of concomitant cardiac diseases. Available drug therapy has major limitations, including incomplete effectiveness, cardiac and extracardiac toxicity and risk of life-threatening proarrhythmic complications (antiarrhythmic agents), and bleeding (anticoagulants) [8,9,10,11]. There is a continuing need for new drugs, device, and ablative approaches to rhythm restoration, and simpler and safer stroke prevention regimens are needed for AF patients on life-long anticoagulation [12]. Stroke prevention, acute conversion, and maintenance of sinus rhythm in patients with atrial fibrillation
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