Pharmacologic Management of Atrial Fibrillation and Flutter

Abstract

Atrial fibrillation is the most commonly encountered arrhythmia requiring therapy and is associated with significant morbidity, a reduced quality of life, an increased risk for mortality, a significant likelihood of hospitalization, an increased risk for stroke and systemic embolism, and significant costs Both rate control and rhythm control have been shown to improve quality of life. Neither as a strategy has been proven to reduce mortality versus the other; however, in some series the attainment and maintenance of sinus rhythm has had superior outcomes if risks from therapy are not encountered (especially those of amiodarone) In patients with markers of an increased risk for stroke, anticoagulation with warfarin is essential. In all patients, rate control is also necessary so as to reduce both symptoms and the risk for a tachycardia-induced cardiomyopathy The choice of rhythm control strategy must be individualized based on patient characteristics This chapter will review the considerations necessary for choosing appropriate pharmacologic therapies as well as the therapeutic agents themselves