The selection among fee or rhythm manage depends on person patient traits. The key treatment alternatives for AF are proven in Figure one. Anti-coagulation should really be continued in patients at risk of stroke,27 and it is frequently advised even immediately after restoration of usual sinus rhythm. Fee and rhythm handle Correction in the underlying arrhythmia in AF may well seem for being the ideal treatment choice. Nonetheless, fee control has been shown for being at the least as powerful in strengthening mortality, stroke rate, AF symptoms and QoL.28,29 Charge manage has also been shown to be a even more Tivantinib cost-effective method than rhythm manage, with lowered health-related resource specifications.thirty In the emergency setting, the priority is to keep haemodynamic stability by urgently restoring sinus rhythm or controlling ventricular fee. Direct current cardioversion really should be thought about for AF individuals that are haemodynamically unstable, or who display indications of myocardial ischaemia or heart failure.2,31 If AF has presented just lately as well as the patient is haemodynamically secure, cardioversion with anti-arrhythmic medication could very well be productive. Class IC agents, this kind of as flecainide or propafenone, are regularly utilized in stable AF.
31 If AF continues to be existing for >48 hrs, atrial thrombus will have to be excluded and adequate anti-coagulation initiated. Class IC anti-arrhythmics usually are not advised for elderly AF sufferers attributable to the chance of co-morbidities, this kind of as coronary artery disease or left ventricular dysfunction. In screening compounds selleck chemicals these patients, and where arrhythmia has persisted for >1 week, a class III agent, this kind of as amiodarone may well be favored.31 Anti-arrhythmic agents differ within their mode of administration, efficacy in restoring and sustaining sinus rhythm, and are connected with proarrhythmogenic results, critical side-effects and drug?drug interactions. Amiodarone has confirmed rather productive for upkeep of sinus rhythm right after cardioversion, but its use is constrained by side-effects, like heart disturbances .31 In one trial in elderly AF patients, the newly launched agent, dronedarone, decreased AF recurrence versus placebo, and in addition had valuable results on cardiovascular mortality/morbidity, while the main difference for all-cause death was statistically non-significant. Dronedarone treatment also lacked a lot of the sideeffects related with amiodarone.32 Dronedarone is, even so, thought about to be less useful than amiodarone. Even having a wide range of anti-arrhythmic drugs and repeated external cardioversions, only 39?63% of AF individuals retain sinus rhythm.28,29 Charge handle may possibly for this reason be a valuable option system, especially in elderly patients.