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 .
Comparative study of efficacy and safety of low-dose diltiazem or betaxolol in combination with digoxin to control ventricular rate in chronic atrial fibrillation: randomized crossover study.
BACKGROUND The combination therapy of low-dose diltiazem or bexatolol with digoxin can be a useful adjunct for achieving heart rate control with minimal side effects . But there has not been a study including patients with impaired left ventricular function and evaluating whether the beneficial effects of medication will be maintained during a follow-up period . OBJECTIVES The purpose of this study was three-fold : ( 1 ) to compare the efficacy of digoxin with low-dose diltiazem and digoxin with low-dose betaxolol on r and omized crossover study ; ( 2 ) to evaluate whether the beneficial effects of medication will be maintained after 7 months ; ( 3 ) to evaluate the safety of the combination therapy in patients with impaired left ventricular function . METHODS We did a prospect i ve r and omized crossover study in 35 patients with chronic atrial fibrillation ( AF ) including 15 patients with left ventricular dysfunction . After enrollment , each patient was evaluated for heart rate , blood pressure , rate-pressure products , maximal exercise tolerance at rest and during symptom-limited treadmill test before medication , at 4 weeks after medication of digoxin ( 0.125 - 0.5 mg daily ) with diltiazem ( 90 mg twice daily ) , and at 4 weeks after digoxin with betaxolol ( 20 mg once daily ) . We performed 24-h ambulatory electrocardiogram ( ECG ) in 15 patients at the end of each phase of treatment . We repeated symptom-limited treadmill test like above method in 15 patients at 7 months of medication . RESULTS ( 1 ) Ventricular rates were significantly reduced in digoxin with low-dose betaxolol therapy at rest and during exercise ( 67 + /- 3 , 135 + /- 5 ( mean + /- S.E.M. ) beats/min , respectively ) in comparison to digoxin with low-dose diltiazem therapy ( 80 + /- 7 , 154 + /- 5 ) ( P < 0.05 ) . ( 2 ) Rate-pressure products were significantly less in digoxin with low-dose betaxolol at rest and during exercise ( 85 + /- 4 , 213 + /- 12 x 10(2 ) mmHg/min ) than in digoxin with low-dose diltiazem therapy ( 105 + /- 6 , 269 + /- 12 ) ( P < 0.05 ) . ( 3 ) Exercise capacity was significantly improved in digoxin with low-dose betaxolol ( 9.3 + /- 0.5 METS ) or digoxin with low-dose diltiazem ( 9.7 + /- 0.5 ) in comparison to control state ( 8.3 + /- 0.5 ) ( P < 0.05 ) . ( 4 ) At 7 months evaluation , there was no significant difference between at 4 weeks and at 7 months . ( 5 ) Results on 24-h ambulatory ECG showed the same findings as on treadmill test . ( 6 ) Although side effects occurred more frequently in digoxin with low-dose betaxolol therapy , they were minimal and no patient had to withdraw medication . Worsening of left ventricular dysfunction was not observed . CONCLUSION Our study suggested that ( 1 ) combination therapy of low-dose betaxolol with digoxin was more superior to low-dose diltiazem with digoxin in controlling ventricular rate and reducing rate-pressure products ; ( 2 ) the effects controlling ventricular rate , reducing rate-pressure products and improving exercise capacity have been well maintained even after 7 months of medication with each combination therapy
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 .