Atrial fibrillation (AF) represents the most common sustained heart rhythm abnormality. It presents in paroxysmal and persistent forms. The pathogenesis of AF is still debatable with several proposed mechanisms. The main pathway for diagnosis of AF is through electrocardiographic record. Treatment strategies can be divided into two strategies: rate and rhythm control. For rhythm control, antiarrhythmic drugs, direct current cardioversion, and electrophysiological ablation are used, while for rate control, chronotropic drugs are being used, while AV node ablation is required in order to reduce rapid ventricular rate, which is often observed in patients with AF. The rhythm control strategy implies the use of cardioversion to convert AF to normal, sinus rhythm. Cardioversion can be either pharmacological or electrical. Rate control strategy can be implied to patients with permanent AF but should also imply for the patients with paroxysmal AF when relapse occurs. Rapid ventricular rates can cause palpitations or even a syncope and other rate-related symptoms; however, these high ventricular rates lead to degradation of left ventricle performance, mitral regurgitation, and further dilatation of the left atrium. The main antiarrhythmic drugs used in treatment of AF are propafenone, flecainide, beta-blockers, amiodarone, dronedarone, dofetilide, vernakalant, and ranolazine.
Part of the book: Epidemiology and Treatment of Atrial Fibrillation