RHYTHM MANAGEMENT IN ATRIAL-FIBRILLATION - WITH A PRIMARY EMPHASIS ONPHARMACOLOGICAL THERAPY - PART 2

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, published previousl y dealt with rate control. Part 2, the current article, details approa ches to the restoration of sinus rhythm by electrical and pharmacologi cal means. The former may use transthoracic or catheter-based energy d elivery systems. The Jotter may use intravenous or oral drug approache s. Part 3, to be published in a subsequent edition of PACE will deal w ith the maintenance of sinus rhythm.