Treatment of atrial fibrillation

Abstract

Novel antiarrhythmic agents, including atrial specific agents with improved efficacy and safety profile, are currently under development. New antithrombotic agents with efficacy similar to warfarin which do not require regular INR testing appear to be promising, but there are lack of data about their long-term safety. There is increasing evidence that inflammation and fibrosis may play a major role in the initiation and maintenance of AF. Statins by means of their pleotropic effects and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers by preventing atrial remodelling may prove useful in preventing the development of AF. However, there is insufficient evidence to expand the use of these agents to a wider patient population at risk of AF. It needs to be seen if strategies towards primary and secondary prevention with treatment of underlying heart disease and modification of risk factors have a larger effect than specific interventions in preventing the burden of AF in the general population.

How I treat age-related morbidities in elderly persons with hemophilia

“…In principle, oral anticoagulation with vitamin K antagonists should be chosen in PWHs at high risk of embolization and stroke (CHADS 2 score of Ն 2). [59][60][61] In practice, vitamin K antagonists are chosen only when baseline FVIII levels are at least 30 U/dL because in severe and moderate hemophilia these drugs would require the use of continuous prophylaxis during the whole period of treatment, entailing a huge consumption of CFC and exorbitant costs. Hence, low-dose aspirin (100 mg daily) is usually preferred because this antiplatelet agent, although less efficacious than vitamin K antagonists in persons without hemophilia, 60 warrants much lower trough levels of coagulation factors (5 U/dL) to avoid significant bleeding in PWHs (Figure 1).…”

Single High Oral Dose Amiodarone for Cardioversion of Recent Onset Atrial Fibrillation

“…Ibutilide, given as a single intravenous infusion over 20 min has been shown to be highly effective and to act relatively quickly. The efficacy rate for intravenous Ibutilide ranges from 65% to 95% depending on the patient profile and the time of onset of AF [14]. It is more effective for atrial flutter than atrial fibrillation with the success rate of 60% at 3 h of therapy.…”

Pharmacologic and Non-Pharmacologic Treatment of Chronic Atrial Fibrillation – With Special Reference to Valvular Atrial Fibrillation in Rheumatic Heart Disease

“…Expensive antiarrhythmic drugs and interventional procedures are other important factors that raise the costs of AF care. Four major aspects should be considered in the AF management 9 : i. Symptom control by slowing ventricular response during paroxysmal or persistent AF and long-term rate control in permanent AF ii.…”