ACUTE TREATMENT OF ATRIAL-FIBRILLATION - WHY AND WHEN TO MAINTAIN SINUS RHYTHM

Although not usually immediately life threatening, atrial fibrillation (AFib) poses a significant long-term risk to health. The best-documen ted and probably largest long-term risk in this condition is from thro mboembolic complications, but this has been shown to be largely overco me by moderate intensity anticoagulation. in addition, however, AFib h as significant detrimental effects on exercise capacity and overall qu ality of life, can cause or exacerbate heart failure, and imposes sign ificant healthcare burdens. Cardioversion, usually by transthoracic di rect current shock, restores sinus rhythm in >80% of patients, but rec urrence of AFib over the weeks and months that follow decreases the va lue of this strategy. Antiarrhythmic drugs lessen the recurrence rate and add to the overall efficacy of achieving the treatment goal of res toring and maintaining sinus rhythm, rather than accepting permanent A Fib with ventricular rate control one! long-term thromboembolic prophy laxis. Whereas clear evidence exists that abolishing AFib makes patien ts feel better in the short-to-medium term, data on the economic viabi lity or long-term efficacy of such a strategy are sparse. Management t rials in AFib currently ongoing will provide some answers, but the dec ision as to whether restoring sinus rhythm is feasible and realistic i n individual patients will remain a decision to be made on a case-by-c ase basis. (C) 1998 by Excerpta Medica, Inc.