RHYTHM MANAGEMENT IN ATRIAL-FIBRILLATION - WITH A PRIMARY EMPHASIS ONPHARMACOLOGICAL THERAPY - PART 1

Atrial fibrillation (AF) is the most common, sustained, symptomatic ta chyarrhythmia that clinicians are called upon to manage. Management st rategies include ventricular rate control coupled with anticoagulation , versus restoration and maintenance of sinus rhythm. Rate control may be achieved pharmacologically, with agents that impair AV nodal condu ction directly and/or by increasing parasympathetic/sympathetic balanc e, or by modifying or ablating the AV nodal region anatomically. Rhyth m control may be achieved by electrical or pharmacological conversion followed by maintenance of sinus rhythm by pharmacological (or occasio nally ablative) therapies. This article will present current approache s to rate and rhythm control issues in AF. Part 1, the current manuscr ipt, details approaches to rate control and includes a drug selection algorithmic conclusion. it also introduces the subject of the pursuit of sinus rhythm. Parts 2 and 3, to be published in subsequent editions of PACE, will deal with therapeutic measures to restore and maintain sinus rhythm.