Cardioversion of Recent Onset Atrial Fibrillation: Which Drug to Prefer in the Individual Patient?

摘要

The management of atrial fibrillation (AF) still represents one of the therapeutic challenges of modern cardiology. This arrhythmia is extremely common, particularly in elderly persons and in patients with organic heart disease, and carries the risk of embolic complications, especially cerebrovascular accidents [1,2].Notwithstanding the controversy relating to the publication of recent studies which compare the strategies of rate control versus rhythm control [3, 4], there is a concept supporting the prompt restoration and maintenance of sinus rhythm whenever possible. Experimental studies [5,6] suggest that remodeling of the atria during AF can lead to persistent electrical and structural changes that may develop within a relatively short period. This finding suggests that cardioversion should be performed as early as possible after the onset of the arrhythmia. Prompt treatment may result in a higher success rate in restoring sinus rhythm and may prevent recurrences of AF. Several potential benefits of this strategy include relief of symptoms, prevention of tachycardia-induced dysfunction, improved exercise capacity and quality of life, and a possible reduction in embolic risk and improved survival.