Atrial fibrillation: Overview of therapeutic trials

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia tr eated by physicians, and a plethora of therapeutic trials deal with selecte d aspects of its management. This overview attempts to categorize and summa rize the available studies. A key to manage ment of AF is a clinical classi fication schema that provides a Framework for application of the available treatment modalities. Such a classification is provided. Antithrombotic tri als have demonstrated the remarkable efficacy of warfarin and more modest e ffect of acetylsalicylic acid for prevention of stroke; these data are summ arized. Cardioversion to restore sinus rhythm is an important aspect ui man agement of AF, particularly of persistent and new onset AF. In this review pharmacological cardioversion is emphasized. The data concerning the use of various drugs for pharmacological cardioversion are reviewed. Many, but no t ail, agents have been shown to have efficacy in this regard, but efficacy with drugs is lower than that with electrical cardioversion and, in the ca se of amiodarone, may be delayed. For recurrent AF, the two major rhythm ma nagement approaches are maintenance of rhythm and heart rate control. Trial s of pharmacological and nonpharmacological therapies for these purposes ar e reviewed and summarized. Management of AF is an active area oi research, and the present review is intended as a foundation upon which new informati on can be added.