Atrial fibrillation: conventional wisdom reappraised.
For years the conventional approach to treatment of atrial fibrillation has centered around use of digoxin for rate control and type IA agents for conversion to normal sinus rhythm and has avoided use of anticoagulation therapy for most patients. Current data suggest that new conventions are needed. beta-Blockers or calcium channel blockers should be considered equal to, if not better than, digoxin for rate control. Type IA agents are still the drugs of choice for conversion to and maintenance of normal sinus rhythm, but the newer agents propafenone and flecainide, and perhaps even amiodarone, may be more efficacious if preliminary data are truly indicative of their effect. The use of antiarrhythmic agents requires caution and careful attention to factors that may predispose patients to their inherent proarrhythmic effects. Finally, anticoagulation therapy is no longer reserved for a few patients but should be used in low doses in most patients (when not contraindicated) to lower risk of stroke. This new approach must be challenged as well to minimize the morbidity and mortality of this common clinical problem.
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