ACUTE TREATMENT OF ATRIAL-FIBRILLATION

Atrial fibrillation (AFib) is a common clinical entity, responsible fo r significant morbidity and mortality, but it also accounts for a larg e percentage of healthcare dollar expenditures, Efforts to treat this arrhythmia in the past have focused on subacute antithrombotic therapy and eventually use of antiarrhythmic drugs for maintenance of sinus r hythm. However, there has been a growing interest in the concept of ac ute electrical and pharmacologic conversion. This treatment strategy h as a number of benefits, including immediate alleviation of patient sy mptoms, avoidance of antithrombotic therapy, and prevention of electro physiologic remodeling, which is thought to contribute to the perpetua tion of the arrhythmia. There is also increasing evidence that this is a cost-effective strategy in that it may obviate admission to the hos pital and the cost of long-term therapy. This article represents a sum mary of the treatments that may be used acutely to control the ventric ular response to AFib, prevent thromboembolic events, and provide for acute conversion either pharmacologically or electrically. it includes information on modalities that are currently available and those that are under active development. We anticipate that an active, acute tre atment approach to AFib and atrial flutter will become the therapeutic norm in the next few years, especially as the benefits of these inter ventions are demonstrated in clinical trials. (C) 1998 by Excerpta Med ica, Inc.