Management of atrial fibrillation and atrial flutter

pp 447-455

Abstract

Atrial fibrillation is one of the commonest cardiac arrhythmias and is clearly associated with major risks such as cerebral and sistemic emboli, congestive heart failure, deletereous hemodynamic effects, shortening of life expectancy and a considerable economic burden in hospitalization and management costs. The Framingham study had shown that atrial fibrillation is associated with a double general and cardiovascular mortality. Even short atrial fibrillation periods may predispose to the appearance of the chronic form. The big challenge for the internist is to recover the sinus rhythm before the arrhythmia became chronic. Reversion to sinus rhythm can be obtained through DC shocks, transvenous atrial cardio version or drugs. Ventricular rate can be controlled with digoxin, diltiazem, verapamil, adenosine, propranolol and esmolol. However those agents are not usually effective in reverting the arrhythmia. Digitalis, calcium antagonists and beta-blockers should not be given to patients with W-P-W syndrome mainly because of the risk of an accelerated input through the anomalous pathway and the chance to induce ventricular tachycardia.