Management of patients with atrial fibrillation

Hurst, J. Willis; Paulk, Elizabeth; Proctor, Herbert D.; Schlant, Robert C.

doi:10.1016/0002-9343(64)90021-x

Cited by 119 publications

(29 citation statements)

References 58 publications

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“…Hurst et al [5] consider that they owe to quinidine the successful maintenance of sinus rhythm in 117 patients previously submitted lo cardioversion. However, in 38 of their patients toxic symptoms necessitated the withdrawal of the drug.…”

Section: Commentsmentioning

confidence: 99%

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Long-Term Results of Conversion of Atrial Fibrillation by Direct Current Countershock

Coelho¹,

Ls²,

As³

et al. 1967

Cardiology

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Section: Commentsmentioning

confidence: 99%

“…Some authors [5] systematically submit their patients to anticoagulants. In our experience, no incon venience resulted from a limited indication of anticoagulants only in those patients with a past history of embolism.…”

Section: Commentsmentioning

confidence: 99%

Long-Term Results of Conversion of Atrial Fibrillation by Direct Current Countershock

Coelho¹,

Ls²,

As³

et al. 1967

Cardiology

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“…The current guidelines for anticoagulating patients in atrial fibrillation who are to be cardioverted is based primarily on clinical observations, numerous uncontrolled case series, two retrospective trials, and one prospective nonrandomized controlled trial. Anticoagulation for 3 weeks before cardioversion followed by 4 weeks of anticoagulation after cardioversion is a theoretically sound and effective approach to reduce the risk of thromboembolic events. The use of transesophageal echocardiography to rule out thrombus and thus identify low-risk patients who may undergo cardioversion without preceding anticoagulation has been supported by several small studies that successfully used this strategy.…”

mentioning

confidence: 99%

Prevention of embolic events after cardioversion of atrial fibrillation. Current and evolving strategies

Kinch¹

1995

Archives of Internal Medicine

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We review the incidence of embolic events following cardioversion of atrial fibrillation, as well as the literature that forms the basis for the current strategy of anticoagulation before, and following, cardioversion to reduce the risk of post-cardioversion embolism. We evaluate a new strategy that uses transesophageal echocardiography to identify patients in atrial fibrillation without atrial thrombi who may be safely cardioverted without preceding anticoagulation and we also address the embolic event and anticoagulation issues in patients with atrial flutter. Cardioversion of atrial fibrillation to sinus rhythm is associated with a small but significant risk of thromboembolic events (average incidence, 1.5%; range, 0% to 7%). Anticoagulating these patients before cardioversion appears to significantly reduce this risk, and because of the delay in return of atrial contraction, anticoagulation should be continued for several weeks following cardioversion. The current guidelines for anticoagulating patients in atrial fibrillation who are to be cardioverted is based primarily on clinical observations, numerous uncontrolled case series, two retrospective trials, and one prospective nonrandomized controlled trial. Anticoagulation for 3 weeks before cardioversion followed by 4 weeks of anticoagulation after cardioversion is a theoretically sound and effective approach to reduce the risk of thromboembolic events. The use of transesophageal echocardiography to rule out thrombus and thus identify low-risk patients who may undergo cardioversion without preceding anticoagulation has been supported by several small studies that successfully used this strategy. However, the demonstration of a postcardioversion atrial and atrial appendage "stunning" suggests that anticoagulation needs to be given at the time of, and following, cardioversion. While promising, this transesophageal echocardiography--guided strategy for cardioversion of patients in atrial fibrillation requires more rigorous study before its routine use can be recommended. The current management of pure atrial flutter requires no anticoagulation before cardioversion; however, several clinical observation suggest theoretical risks for embolic events in these patients, thus further investigation of this strategy may be warranted.

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“…Clinically AF may be classified as chronic, paroxysmal, and subacute. Chronic AF lasts more than 4-6 weeks [10,11]. Paroxysmal AF is an acute type of AF that is accompanied by some subjective symptoms.…”

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confidence: 99%

The pharmacologic treatment of atrial fibrillation

Bolognesi

1991

Cardiovasc Drug Ther

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The pharmacologic treatment of atrial fibrillation (AF) is aimed at controlling the ventricular response, restoring sinus rhythm, and preventing or delaying relapses. In the control of ventricular response, digitalis maintains a primary role when the arrhythmia is accompanied by heart failure. In ischemic, hypertensive, and degenerative (whose number is increasing at present) cardiopathies without evident ventricular dilatation, treatments with calcium antagonists (such as verapamil, gallopamil, or diltiazem) or beta-blocking agents must be preferred. In order to control the ventricular response in patients with chronic AF during physical activity, the association of digitalis with beta-blocking agents or calcium antagonists seems to provide satisfactory results. The drugs of the IC class, especially flecainide, represent a certain therapeutical progress in the restoration of sinus rhythm in the treatment of paroxysmal atrial fibrillation affecting subjects without evident alterations of ventricular function, particularly in subjects with Wolff-Parkinson-White syndrome, with forms of vagal origin, or with atrial fibrillation alone. A therapeutic combination of digitalis and quinidine may produce resolution of the arrhythmia in the presence of altered ventricular function or when AF is of an uncertain onset. In patients with hypertensive, ischemic, and/or degenerative cardiopathy without evident ventricular or advanced heart failure, the verapamil-quinidine association may also be effective and even quicker. The combination of drugs of the I and III class for restoration of the sinus rhythm in particularly resistant forms of AF without evident structural heart alterations is promising but must be verified in a greater number of patients. In the prevention of relapses amiodarone appears to have the widest spectrum of advantages from an electrophysiologic point of view; however, because of its many side effects, amiodarone represents a late therapeutical choice. The promising results obtained with flecainide are disputed by the results of the CAST, which limit the possibilities of using this drug to a low number of cases (W.P.W. syndrome, AF of vagal origin, atrial fibrillation alone). In the past, quinidine and disopyramide have been the drugs most widely used in the prophylaxis of AF. These drugs have a similar efficacy, and both of them provided some positive results. However, because of untoward side effects (especially for quinidine) during chronic treatment, the use of these drugs has been questioned. Perhaps in the majority of patients, the less dangerous therapeutic choice after the termination of the fibrillation is a combination of drugs slowly down AV node activity (digitalis or calcium antagonists and beta blockers) with class IA antiarrhythmics.

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Management of patients with atrial fibrillation

Cited by 119 publications

References 58 publications

Long-Term Results of Conversion of Atrial Fibrillation by Direct Current Countershock

Long-Term Results of Conversion of Atrial Fibrillation by Direct Current Countershock

Prevention of embolic events after cardioversion of atrial fibrillation. Current and evolving strategies

The pharmacologic treatment of atrial fibrillation

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