ATRIAL-FIBRILLATION - PEARLS AND PERILS OF MANAGEMENT

Atrial fibrillation, a common arrhythmia, is responsible for considera ble cardiovascular morbidity. Its management demands more than antiarr hythmic therapy alone, but must address the causes and consequences of the arrhythmia. Although remediable causes are infrequently found, a thorough search for associated heart disease or its risk factors resul ts in better-informed patient management. Controlling the ventricular response and protecting from thromboembolic complications are importan t initial goals of therapy and may include the administration of aspir in in younger, low-risk patients. Older patients and those with risk f actors for systemic embolism are not adequately protected from stroke complications by aspirin therapy alone. It remains controversial wheth er all high-risk patients should receive warfarin and at what intensit y. Whether and how sinus rhythm should be restored and maintained pose s the greatest therapeutic controversy for atrial fibrillation. The mo rtal risk of antiarrhythmic therapy is substantially greater in patien ts with evidence of heart failure. In such persons, the risks and bene fits of maintaining normal sinus rhythm with antiarrhythmic medication s should be weighed carefully. A definitive cure for atrial fibrillati on remains elusive, but promising surgical and catheter ablation thera pies are being developed.