They also have an increased risk for thromboembolism .
Comparing with age-matched controls , the relative risk for stroke is increased 2- to 7-fold in patients with nonrheumatic atrial fibrillation ( 3 , 8 , 13 ) , and the absolute risk for stroke is between 1 % and 5 % per year , depending on clinical characteristics ( 3 , 12 , 14 - 16 ) .
Paroxysmal atrial fibrillation disrupts the lives of patients ( 17 ) , but this perception may not be associated with frequency or duration of symptoms .
Warfarin therapy affects quality of life because of frequent blood testing and recommendations for limiting some activities .
Data Synthesis Does Aggressive Rhythm Control Improve Mortality and Morbidity Compared with Rate Control ?
Atrial fibrillation is the most common type of arrhythmia in adults , accounting for about one third of hospitalizations for arrhythmia ( 1 ) .
The prevalence increases from less than 1 % in persons younger than 60 years of age to more than 8 % in those older than 80 years of age ( 2 - 6 ) .
The incidence ranges from 0.2 % per year for men 30 to 39 years of age to 2.3 % per year in men 80 to 89 years of age ( 7 , 8) .
The age-adjusted incidence for women is about half that of men ( 9 ) .
The cardiac conditions most commonly associated with atrial fibrillation are rheumatic mitral valve disease , coronary artery disease , congestive heart failure , and hypertension ( 8 , 10 ) .
Noncardiac causes include hyperthyroidism , hypoxic conditions , surgery , and alcohol intoxication .
A predisposing condition exists in more than 90 % of cases ( 5 , 11 , 12 ) ; the remaining cases have what is called lone atrial fibrillation .
Patients with atrial fibrillation frequently have symptoms of hemodynamic compromise , ranging from irregular palpitations to the more insidious feeling of malaise .
Little is known about the direct effects of antiarrhythmic therapy and rate-control therapy on quality of life .
The American College of Cardiology/American Heart Association/European Society of Cardiology Task Force on Clinical Guidelines for the Management of Atrial Fibrillation classified atrial fibrillation into 4 types ( 20 ) : first detected episode , paroxysmal ( terminates spontaneously ) , persistent ( electrical or pharmacologic termination necessary ) , and permanent ( resistant to electrical or pharmacologic conversion or accepted by the physician ) .
The purpose of this review was to summarize the evidence that was available during formulation of the guidelines developed by the American College of Physicians ( ACP ) and the American Academy of Family Physicians ( AAFP ) for management of adult patients with nonpostoperative atrial fibrillation .
Although the relative benefits and risks of rate versus rhythm control are of paramount importance in the management of atrial fibrillation , studies directly addressed this issue only recently .
Oxygen uptake kinetics and cardiopulmonary performance in lone atrial fibrillation and the effects of sotalol.
BACKGROUND Atrial fibrillation ( AF ) is associated with impaired exercise capacity . Oxygen uptake ( VO2 ) kinetics determines cardiopulmonary performance during submaximal exercise , which may be impaired in patients with AF . AIM To study oxygen kinetics and cardiopulmonary performance in patients with AF without structural heart disease and the effects of oral sotalol on these parameters . PATIENTS AND METHODS Twenty consecutive patients ( mean age , 56+/-8 years ) with chronic AF were recruited . The protocol design was a r and omized , single-blinded , and placebo-controlled trial . Patients received either sotalol or placebo for an 8-week study period , and the alternative treatment in the subsequent period .  Cardiopulmonary function tests  using constant workload and incremental workload protocol s were performed at the end of each phase . Sixteen age-matched normal subjects were included as control subjects . RESULTS During constant submaximal exercise , patients with AF had a larger oxygen deficit ( 425+/-140 mL vs 289+/-80 mL in normal subjects ; p<0.05 ) and the time for achieving 63 % of VO2 ( mean response time ) was also delayed ( 46+/-15 s vs 33+/-10 s ; p<0.05 ) . Compared with normal subjects , patients with chronic AF had a higher maximal exercise heart rate ( 180+/-34 beats/min vs 153+/-22 beats/min ; p<0.05 ) , but a lower maximal VO2 ( 20+/-4 mL/kg/min vs 26+/-6 mL/kg/min ; p<0.05 ) . Oral sotalol lowered the resting ( 72+/-15 beats/min vs 93+/-22 beats/min ; p<0.05 ) and exercise heart rate compared with placebo ( 125+/-27 beats/min vs 180+/-34 beats/min ; p<0.05 , respectively ) , and normalized oxygen pulse and the heart rate to minute ventilation ratio during maximal exercise . There was no significant difference between those receiving sotalol and those receiving placebo in oxygen deficit ( 502+/-150 mL vs 425+/-140 mL ; p=0.38 ) , maximal VO2 ( 17.2+/-4.9 mL/kg/min vs 20.4+/-4.7 mL/kg/min ; p=0.17 ) , and other gas exchange variables . In patients with AF , oxygen deficit has a fair correlation with VO2 at the anaerobic threshold ( r2=0.43 ; p<0.05 ) and at maximal exercise ( r2=0.45 ; p<0.05 ) . CONCLUSION In addition to maximal exercise capacity and cardiopulmonary performance , patients with chronic AF without significant structural heart disease had impaired submaximal exercise performance as assessed by VO2 kinetics . These parameters were not significantly affected by sotalol used for rate control
They also have an increased risk for thromboembolism .
Comparing with age-matched controls , the relative risk for stroke is increased 2- to 7-fold in patients with nonrheumatic atrial fibrillation ( 3 , 8 , 13 ) , and the absolute risk for stroke is between 1 % and 5 % per year , depending on clinical characteristics ( 3 , 12 , 14 - 16 ) .
Paroxysmal atrial fibrillation disrupts the lives of patients ( 17 ) , but this perception may not be associated with frequency or duration of symptoms .
Warfarin therapy affects quality of life because of frequent blood testing and recommendations for limiting some activities .
Data Synthesis Does Aggressive Rhythm Control Improve Mortality and Morbidity Compared with Rate Control ?
Atrial fibrillation is the most common type of arrhythmia in adults , accounting for about one third of hospitalizations for arrhythmia ( 1 ) .
The prevalence increases from less than 1 % in persons younger than 60 years of age to more than 8 % in those older than 80 years of age ( 2 - 6 ) .
The incidence ranges from 0.2 % per year for men 30 to 39 years of age to 2.3 % per year in men 80 to 89 years of age ( 7 , 8) .
The age-adjusted incidence for women is about half that of men ( 9 ) .
The cardiac conditions most commonly associated with atrial fibrillation are rheumatic mitral valve disease , coronary artery disease , congestive heart failure , and hypertension ( 8 , 10 ) .
Noncardiac causes include hyperthyroidism , hypoxic conditions , surgery , and alcohol intoxication .
A predisposing condition exists in more than 90 % of cases ( 5 , 11 , 12 ) ; the remaining cases have what is called lone atrial fibrillation .
Patients with atrial fibrillation frequently have symptoms of hemodynamic compromise , ranging from irregular palpitations to the more insidious feeling of malaise .
Little is known about the direct effects of antiarrhythmic therapy and rate-control therapy on quality of life .
The American College of Cardiology/American Heart Association/European Society of Cardiology Task Force on Clinical Guidelines for the Management of Atrial Fibrillation classified atrial fibrillation into 4 types ( 20 ) : first detected episode , paroxysmal ( terminates spontaneously ) , persistent ( electrical or pharmacologic termination necessary ) , and permanent ( resistant to electrical or pharmacologic conversion or accepted by the physician ) .
The purpose of this review was to summarize the evidence that was available during formulation of the guidelines developed by the American College of Physicians ( ACP ) and the American Academy of Family Physicians ( AAFP ) for management of adult patients with nonpostoperative atrial fibrillation .
Although the relative benefits and risks of rate versus rhythm control are of paramount importance in the management of atrial fibrillation , studies directly addressed this issue only recently .