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Selecting an antiarrhythmic agent for atrial fibrillation should be a patient-specific, data-driven decision.

Publication ,  Journal Article
Reiffel, JA
Published in: Am J Cardiol
October 16, 1998

Selecting an antiarrhythmic agent for atrial fibrillation (AF) should be a patient-specific decision. When possible, it should be based on sound rationale and available clinical data. This article details many of the thought processes that must go into this decision process and offers some suggested algorithmic starting points based on these considerations. With a patient's first episode of AF, termination is appropriate, but antiarrhythmic therapy should usually be withheld in order to assess the recurrence pattern. However, if severe hemodynamic or ischemic intolerance would make recurrence a serious risk, or if an early symptomatic recurrence is highly likely, antiarrhythmic therapy would be appropriate. Acute AF may terminate spontaneously or may be terminated iatrogenically. The latter may be achieved by direct current or pharmacologic approaches. The risks, benefits, and optimum utility of these approaches are addressed in the article. Infrequent recurrences may be treated with cardioversion; frequent or severely symptomatic episodes are best treated with attempts at suppression with chronic antiarrhythmic drug administration. Since the therapeutic efficacy of maintaining sinus rhythm is similar for the currently available agents, the drug selection process should be based in large part on safety and convenience considerations. The factors underlying this selection process and one suggested algorithm for drug choice are provided in this article.

Duke Scholars

Published In

Am J Cardiol

DOI

ISSN

0002-9149

Publication Date

October 16, 1998

Volume

82

Issue

8A

Start / End Page

72N / 81N

Location

United States

Related Subject Headings

  • Humans
  • Electric Countershock
  • Cardiovascular System & Hematology
  • Atrial Fibrillation
  • Arrhythmias, Cardiac
  • Anti-Arrhythmia Agents
  • Algorithms
  • 1102 Cardiorespiratory Medicine and Haematology
 

Citation

APA
Chicago
ICMJE
MLA
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Reiffel, J. A. (1998). Selecting an antiarrhythmic agent for atrial fibrillation should be a patient-specific, data-driven decision. Am J Cardiol, 82(8A), 72N-81N. https://doi.org/10.1016/s0002-9149(98)00588-8
Reiffel, J. A. “Selecting an antiarrhythmic agent for atrial fibrillation should be a patient-specific, data-driven decision.Am J Cardiol 82, no. 8A (October 16, 1998): 72N-81N. https://doi.org/10.1016/s0002-9149(98)00588-8.
Reiffel, J. A. “Selecting an antiarrhythmic agent for atrial fibrillation should be a patient-specific, data-driven decision.Am J Cardiol, vol. 82, no. 8A, Oct. 1998, pp. 72N-81N. Pubmed, doi:10.1016/s0002-9149(98)00588-8.
Journal cover image

Published In

Am J Cardiol

DOI

ISSN

0002-9149

Publication Date

October 16, 1998

Volume

82

Issue

8A

Start / End Page

72N / 81N

Location

United States

Related Subject Headings

  • Humans
  • Electric Countershock
  • Cardiovascular System & Hematology
  • Atrial Fibrillation
  • Arrhythmias, Cardiac
  • Anti-Arrhythmia Agents
  • Algorithms
  • 1102 Cardiorespiratory Medicine and Haematology