This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Khairy, P.
Right arrow Articles by Nattel, S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Khairy, P.
Right arrow Articles by Nattel, S.
Related Collections
Right arrow Arrhythmias
Right arrow Other cardiovascular medicine
Right arrowRelated Article
CMAJ • October 29, 2002; 167 (9)
© 2002 Canadian Medical Association or its licensors

Review
Synthèse

New insights into the mechanisms and management of atrial fibrillation

Paul Khairy and Stanley Nattel

At the time of writing, Dr. Khairy was with the Department of Medicine, Université de Montréal, Montreal, Que. He is now with the Department of Cardiology, Brigham and Women's Hospital and Children's Hospital Boston, Harvard Medical School, Boston, Mass. Dr. Nattel is with the Research Center, Montreal Heart Institute, Université de Montréal, Montreal, Que.

Correspondence to: Dr. Stanley Nattel, Research Center, Montreal Heart Institute, 5000 Bélanger St. E, Montreal QC H1T 1C8; fax 514 376-5241; nattel{at}icm.umontreal.ca

Abstract

ATRIAL FIBRILLATION (AF) IS A COMMON CONTRIBUTOR to cardiovascular morbidity and mortality. Two generally acceptable strategies exist for long-term AF management, with ongoing studies comparing the overall mortality associated with each. One strategy aims to maintain sinus rhythm, with antiarrhythmic agents if necessary, thereby preserving physiological cardiac electrical function but exposing the patient to the potential side effects of potent drugs. The second approach is to control the ventricular rate and prevent thromboembolic complications with anticoagulants, leaving the patient with AF. Both beta-blocking agents and calcium antagonists are more effective than digoxin in achieving rate control. Several nonpharmacological therapies including catheter ablation, implantable devices and surgical interventions show promise for rate control and maintenance of sinus rhythm. This paper provides an overview of new developments in pharmacological and nonpharmacological therapy. Key features of recently published clinical guidelines, including a unified classification scheme for AF and issues relating to rate control and maintenance of sinus rhythm, are considered. In addition, preliminary results from the recently presented AFFIRM study, the largest AF trial to date, are summarized. Finally, we discuss recent insights into the basic mechanisms underlying AF that have potentially significant clinical implications.


Related Article

Highlights of this issue
Can. Med. Assoc. J. 2002 167: 985. [Full Text] [PDF]



This article has been cited by other articles:


Home page
 Journal of Renin-Angiotensin-Aldosterone SystemHome page
R. Laszlo, C. Eick, N. Rueb, S. Weretka, H.-J. Weig, J. Schreieck, and R. F Bosch
Inhibition of the renin-angiotensin system: effects on tachycardia-induced early electrical remodelling in rabbit atrium
Journal of Renin-Angiotensin-Aldosterone System, September 1, 2008; 9(3): 125 - 132.
[Abstract] [PDF]

Home page
 Crit Care NurseHome page
D. Rosborough
Cardiac Surgery in Elderly Patients: Strategies to Optimize Outcomes
Crit. Care Nurse, October 1, 2006; 26(5): 24 - 31.
[Full Text] [PDF]

Home page
 J. Pharmacol. Exp. Ther.Home page
T. C. McCarthy, P. T. Pollak, E. A. Hanniman, and C. J. Sinal
Disruption of Hepatic Lipid Homeostasis in Mice after Amiodarone Treatment Is Associated with Peroxisome Proliferator-Activated Receptor-{alpha}Target Gene Activation
J. Pharmacol. Exp. Ther., December 1, 2004; 311(3): 864 - 873.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
C. M. Pratt, S. N. Singh, H. R. Al-Khalidi, J. M. Brum, M. J. Holroyde, S. R. Marcello, P. J. Schwartz, A. J. Camm, and ALIVE Investigators
The efficacy of azimilide in the treatment of atrial fibrillation in the presence of left ventricular systolic dysfunction: Results from the Azimilide Postinfarct Survival Evaluation (ALIVE) trial
J. Am. Coll. Cardiol., April 7, 2004; 43(7): 1211 - 1216.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
B. G. Krohn, S. Zhuang, Y. Zhang, K. A. Mowrey, T. Tabata, D. W. Wallick, Z. B. Popovic, R. A. Grimm, A. Natale, T. N. Mazgalev, et al.
Inappropriate Use of Atrioventricular Nodal Vagal Stimulation in Atrial Fibrillation * Response
Circulation, April 8, 2003; 107 (13): e90 - e90.
[Full Text] [PDF]

Home page
 CMAJHome page
S. Nattel
Rhythm versus rate control for atrial fibrillation management: what recent randomized clinical trials allow us to affirm
Can. Med. Assoc. J., March 4, 2003; 168(5): 572 - 573.
[Full Text] [PDF]