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Feature Article Cardiovascular medicine
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Recent advances in the treatment of atrial fibrillation

Saurabh Kumar, Jonathan M Kalman
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Abstract
Atrial fibrillation is the most common cardiac arrhythmia seen in clinical practice, occurring in paroxysmal, persistent or permanent forms. New anti-arrhythmic agents are being trialled for the pharmacological treatment of affected patients. Catheter ablation is an effective therapeutic intervention for the treatment of patients with symptomatic, drug-refractory paroxysmal atrial fibrillation.

Correction A correction for this article was published in the November 2012 issue of Medicine Today. The full text PDF of this article (see link above) has been corrected.

Key Points
  • The two main aims of treatment of patients with atrial fibrillation (AF) are symptom control and reduction in thromboembolic risk.
  • Once AF has been diagnosed, either a rate control or rhythm control treatment strategy may be reasonable.
  • Symptomatic patients often derive much greater symptom relief from rhythm control, which may be achieved pharmacologically or with electric cardioversion.
  • The decision to opt for rate control is based on symptoms and likelihood of long-term sinus rhythm maintenance.
  • In the small proportion of patients in whom rate control is difficult to achieve pharmacologically, permanent pacing followed by atrioventricular nodal ablation improves symptoms and quality of life.
  • Catheter ablation is a highly efficacious strategy for maintaining sinus rhythm in patients with symptomatic paroxysmal AF who have failed one or more anti-arrhythmic drugs.
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