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 .
Emergency management of atrial fibrillation and flutter: intravenous diltiazem versus intravenous digoxin.
STUDY OBJECTIVE To compare the effects of i.v . diltiazem and i.v . digoxin on ventricular rate control in the emergency treatment of acute atrial fibrillation and flutter ( AFF ) . METHODS This prospect i ve , r and omized , open-label trial involved 30 consecutive patients who presented with acute AFF to the emergency department of an urban , 420-bed community teaching hospital from April 1993 through March 1994 . Exclusion criteria included systolic blood pressure lower than 100 mm Hg , treatment with calcium-channel blockers other than diltiazem , lack of informed consent , and objection of the private physician . Patients were r and omly assigned to receive either i.v . diltiazem alone , i.v . digoxin alone , or both . Heart rate control was defined as a ventricular rate of less than 100 beats/minute . I.v . digoxin , 25 mg , was given as a bolus at time 0 and at time 30 minutes . An initial dose of .25 mg/kg diltiazem was given intravenously over the first 2 minutes , followed by a dose of .35 mg/kg at time 15 minutes and then a titratable i.v . infusion at a rate of 10 to 20 mg/hour to maintain heart rate control . The dosing regimens were the same whether the drugs were given alone or in combination . Heart rhythm , heart rate , and blood pressure were measured at time 0 , 5 , 10 , 15 , 30 , 60 , 120 , and 180 minutes . Statistical significance was assessed with the use of Student 's t test and ANOVA methodology . RESULTS At time 0 , the heart rate ( mean + /- SD ) was 150 + /- 19 beats/minute in the diltiazem group and 144 + /- 12 in the digoxin group ( difference not significant , P = .432 ) . The decrease in heart rate from time 0 reached statistical significance at time 5 minutes in the diltiazem group ( P = .0006 ) ; the mean rates at time 5 minutes were 111 + /- 26 beats/minute for diltiazem and 144 + /- 13 for digoxin . The decrease in heart rate achieved with digoxin did not reach statistical significance until time 180 minutes ( P = .0099 ) , at which time the rates were 90 + /- 13 for diltiazem and 117 + /- 22 for digoxin . CONCLUSION Treatment of acute AFF with i.v . diltiazem decreases ventricular heart rate significantly within 5 minutes , compared with 3 hours for treatment with i.v . digoxin . No advantage was noted within 3 hours for i.v . treatment with a combination of diltiazem and digoxin . I.v . diltiazem is superior to i.v . digoxin in the emergency control of ventricular rate in acute AFF and should be considered as a drug of choice for this condition . This study was not large enough to adequately assess adverse effects , and further studies may be warranted for clinical validation
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 .