[The treatment of chronic atrial fibrillation]

Abstract

Atrial fibrillation is a common arrhythmia. It is associated with increased morbidity and mortality, in part secondary to an increased rate of thromboembolism. Considering the arrhythmia's duration, a chronic and paroxysmal type can be recognized. Only the former will be discussed here. Treatment of atrial fibrillation should be aimed at restoring sinus rhythm. This may improve exercise tolerance and alleviate symptoms. In addition, it may obviate the need for antithrombotic therapy. Electrical cardioversion is the method of choice to restore sinus rhythm in patients with chronic atrial fibrillation. To prevent arrhythmia relapses, anti-arrhythmic drugs are often prescribed. These drugs, however, may have serious side effects, e.g. proarrhythmia. The pros and cons of antiarrhythmics should therefore be considered seriously before prescribing these drugs. An alternative strategy is to optimize ventricular rate response (usually pharmacologically) while the patient maintains in atrial fibrillation. To prevent thromboembolism, however, the use of antithrombotic is strongly recommended in most of these patients.