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Titolo:
Drug choices in the treatment of atrial fibrillation
Autore:
Reiffel, JA;
Indirizzi:
Columbia Univ Coll Phys & Surg, Dept Med, Div Cardiol, Electrophysiol Serv, New York, NY 10032 USA Columbia Univ Coll Phys & Surg New York NY USA 10032 w York, NY 10032 USA New York Presbyterian Hosp, Columbia Presbyterian Med Ctr, New York, NY USA New York Presbyterian Hosp New York NY USA ian Med Ctr, New York, NY USA
Titolo Testata:
AMERICAN JOURNAL OF CARDIOLOGY
fascicolo: 10A, volume: 85, anno: 2000,
pagine: 12D - 19D
SICI:
0002-9149(20000525)85:10A<12D:DCITTO>2.0.ZU;2-V
Fonte:
ISI
Lingua:
ENG
Soggetto:
LEFT-VENTRICULAR DYSFUNCTION; STRUCTURAL HEART-DISEASE; ARTERY BYPASS-SURGERY; LOW-DOSE SOTALOL; SUPRAVENTRICULAR TACHYARRHYTHMIAS; PHARMACOLOGICAL THERAPY; MYOCARDIAL-INFARCTION; RHYTHM MANAGEMENT; PRIMARY EMPHASIS; INTRAVENOUS IBUTILIDE;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
62
Recensione:
Indirizzi per estratti:
Indirizzo: Reiffel, JA 161 Ft Washington Ave, New York, NY 10032 USA 161 Ft Washington Ave New York NY USA 10032 ork, NY 10032 USA
Citazione:
J.A. Reiffel, "Drug choices in the treatment of atrial fibrillation", AM J CARD, 85(10A), 2000, pp. 12D-19D

Abstract

When considering therapy for atrial fibrillation (AF), the dominant issuesare rate control, anticoagulation, rhythm control, and treatment of any underlying disorder. Drug choices for rate control include beta-blockers, verapamil and diltiazem, and digitalis as first-line agents, with consideration of other sympatholytics, amiodarone, or nonpharmacologic approaches in resistant cases. Anticoagulation may be accomplished with aspirin or warfarin, with the letter preferred in all older or high-risk patients. Antiarrhythmic drug therapy may be used (1) to produce cardioversion (mast effective with ibutilide or class IC agents in recent onset AF); (2) to facilitate electrical conversion (class III agents); (3) to prevent early reversion aftercardioversion; (4) to maintain sinus rhythm during chronic therapy; and/or(5) to facilitate conversion of fibrillation to flutter, which may then beamenable to termination or prevention with antitachypacing or ablative techniques. Antiarrhythmic drug selection for AF is guided by efficacy considerations (mast drugs are similar), by convenience, cost, and discontinuationconsiderations; and, most importantly, by safety considerations. When possible, agents with serious organ toxicity potential and proarrhythmic risk should be avoided as first-line choices. In structurally normal hearts, class IC antiarrhythmic drugs ore least proarrhythmic and least organ toxic (when considered together). In normal hearts, sotatol, dofetilide, and potentially azimilide also appear to have attractive profiles. Amiodarone has low proarrythmic risk bur can produce bradyarrhythmias and toxicity. In hypertrophied hearts, the risk of torsade de pointes with class III/IA agents is enhanced, whereas in ischemia or conditions with impaired cell contact, whether functionally (as by ischemia) or anatomically (as by fibrosis, infiltration, etc), proarrhythmic risk with class I antiarrhythmic drugs (sustainedventricular fibrillation/fluffer) is greatly increased. The class I drugs should be avoided in these circumstances. Additional issues to consider arewhere to initiate therapy (in- or outpatient), what follow-up protocols touse, and whether ta limit therapy to proprietary drugs or to allow genericformulation substitution. Each of these considerations is detailed in thisarticle. (C) 2000 by Excerpta Medico, Inc.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 28/11/20 alle ore 21:49:01