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 .
Intravenous sotalol for the termination of supraventricular tachycardia and atrial fibrillation and flutter: a multicenter, randomized, double-blind, placebo-controlled study. Sotalol Multicenter Study Group.
Sotalol is an antiarrhythmic agent with combined beta-blocking and class III antiarrhythmic properties . This study was design ed to assess the safety and efficacy of sotalol in terminating supraventricular tachycardia ( SVT ) , atrial fibrillation ( AFib ) , and atrial flutter ( AFl ) .  Ninety-three patients with spontaneous or induced SVT ( n = 45 ) or AF ( AFib or AFl ; n = 48 ) with a ventricular rate of > or = 120 beats/min were studied . In the first phase , the double-blind phase , patients were r and omly assigned to receive placebo or intravenous ( i.v . ) sotalol , 1.0 or 1.5 mg/kg . If SVT or AF did not convert to sinus rhythm or if the ventricular rate did not slow to < 100 beats/min within 30 minutes , patients then entered the second phase , the open-label phase , which also lasted 30 minutes , and were given 1.5 mg/kg iv sotalol . In the SVT group , during the double-blind phase conversion to sinus rhythm occurred in 2 ( 14 % ) of 14 of patients who received placebo , 10 ( 67 % ) of 15 who received sotalol , 1.0 mg/kg ( p < 0.05 vs placebo ) , and 10 ( 67 % ) of 15 who received 1.5 mg/kg sotalol ( p < 0.05 vs placebo ) ; during the open-label phase , 1.5 mg/kg i.v . sotalol converted 7 ( 41 % ) of 17 of patients . In the AF group , during the double-blind phase conversion to sinus rhythm occurred in 2 ( 14 % ) of 14 of patients who received placebo , 2 ( 11 % ) of 18 who received 1.0 mg/kg sotalol ( p not significant [ NS ] vs placebo ) , and 2 ( 13 % ) of 16 who received 1.5 mg/kg sotalol ( p = NS vs placebo ) ; in these groups , a > 20 % reduction of ventricular rate without conversion to sinus rhythm occurred in 0 ( 0 % ) of 14 , 13 ( 72 % ) of 18 ( p < 0.05 vs placebo ) , and 12 ( 75 % ) of 16 of patients ( p < 0.05 vs placebo ) , respectively ; during the open-label phase , 1.5 mg/kg i.v . sotalol converted 7 ( 30 % ) of 23 of patients . The most common adverse events were hypotension and dyspnea . During the double-blind phase they occurred in 10 % of patients who received placebo , 9 % of those who received 1.0 mg/kg i.v . sotalol ( p = NS vs placebo ) , and 10 % of those who received 1.5 mg/kg i.v . sotalol ( p = NS vs placebo ) . Most of these events were mild to moderate , but all were transient and clinical ly manageable . ( ABSTRACT TRUNCATED AT 400 WORDS
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 .