Table of Contents
What is rhythm control in atrial fibrillation?
Many patients with atrial fibrillation have substantial symptoms despite ventricular rate control and require restoration of sinus rhythm to improve their quality of life. Acute restoration (ie, cardioversion) and maintenance of sinus rhythm in patients with atrial fibrillation are referred to as rhythm control.
When do you give rhythm control?
Rhythm control is preferred in highly symptomatic patients, those with paroxysmal AF and/or new-onset AF, in younger patients with relatively few medical comorbidities, and those with a history of congestive heart failure exacerbated by AF or AF-related cardiomyopathy.
What is a rate control strategy?
Rate control involves the use of negatively chronotropic drugs or electrophysiological/surgical interventions to reduce the rapid ventricular rate often found in patients with atrial fibrillation.
Is rhythm control better than rate control?
Consistently, Kim et al9 reported that the risk of stroke can be decreased 26% by early rhythm‐control therapy rather than by rate‐control therapy. In this study, rhythm control was associated with less frequent stroke events and a lower risk of stroke when initiated within 16 months of AF diagnosis.
What drugs are rhythm control?
Some typical drugs that are used for rhythm control are flecainide (Tambocor®), propafenone (Rythmol®), quinidine (Various), sotalol (Betapace®), amiodarone (Cordarone®, Pacerone®),1 and dronedarone (Multaq®).
Is cardioversion same as rhythm control?
Cardioversion is performed as part of a rhythm‐control treatment strategy, and if successful restores sinus rhythm. However, not all attempts at cardioversion are successful, and at 1 year after cardioversion approximately 50% of patients again contract atrial fibrillation.
Are beta-blockers rate or rhythm control?
Oral beta-blockers are prescribed commonly as primary therapy for rate control in AF. They are effective in reducing resting and exercise ventricular rates. The more commonly used beta-blockers include metoprolol, atenolol, nadolol, carvedilol, propranolol, bisoprolol and pindolol.
What is rate and rhythm control?
Rhythm control was defined as use of an antiarrhythmic medication, cardioversion, or AF ablation or surgery. Rate control was defined as use of any combination of β‐blocker, calcium channel blocker, and digoxin without evidence of rhythm control.
What’s the difference between rate and rhythm control?
Rate control, the first line of treatment for atrial fibrillation, controls the heart rate without changing its rhythm. It helps to bring your heart rate to a normal level. Rhythm control is used to maintain the heart’s rhythm with no arrhythmias.
Is digoxin a rhythm control?
VENTRICULAR RATE CONTROL Beta blockers, calcium channel blockers, and digoxin (Lanoxin) are the drugs most commonly used for rate control3,4,7 (Table 1). These agents do not have proven efficacy in converting atrial fibrillation to sinus rhythm and should not be used for that purpose.
Is amiodarone a rate or rhythm control?
Amiodarone is the drug recommended for rate control of AF with rapid ventricular response in patients with chronic heart failure in whom beta-blockers cannot be administered. Amiodarone shows little negative inotropic effect and can be used in patients with reduced left ventricular function.
Do you hold anticoagulation before cardioversion?
The recommendations for patients undergoing cardioversion were similar to the European guidelines. Patients should be anticoagulated for ≥3 weeks before elective cardioversion.
Do you give anticoagulation before cardioversion?
Current AF guidelines all recommend 3 weeks of therapeutic anticoagulation with oral anticoagulation therapy (VKA, DTI, or FXa inhibitors) before cardioversion.
How many joules are used for cardioversion?
Cardioversion of ventricular tachycardia (VT, vtach) involves shocks of 50-100 joules initially, and then 200 joules if unsuccessful. Either external paddles or stick-on electrode pads may be used to deliver the electric shocks.
What should INR be for cardioversion?
The target INR was 2.5 (range 2.0–3.0). Investigators had the option to use a parenteral anticoagulant drug in addition to VKA therapy, especially prior to cardioversion, until the target INR was obtained.
Does rhythm control or rate control improve atrial fibrillation and atrial flutter?
Background: Atrial fibrillation and atrial flutter may be managed by either a rhythm control strategy or a rate control strategy but the evidence on the clinical effects of these two intervention strategies is unclear.
Do rhythm control strategies increase the risk of serious adverse events?
Meta-analysis showed that rhythm control strategies versus rate control strategies significantly increased the risk of a serious adverse event (risk ratio (RR), 1.10; 95% confidence interval (CI), 1.02 to 1.18; P = 0.02; I2 = 12% (95% CI 0.00 to 0.32); 21 trials), but TSA did not confirm this result (TSA-adjusted CI 0.99 to 1.22).
What is the focus of rhythm control with antiarrhythmic treatment?
Thus, the focus of rhythm control with antiarrhythmic treatment is on symptom control and improvement of quality of life. Oral drug treatment is considered first-line therapy for long-term outpatient rhythm control.
When is atrial fibrillation ablation used as a first-line rhythm control strategy?
In some cases, atrial fibrillation ablation might be used as a first-line rhythm control strategy before the use of antiarrhythmic drugs after a proper evaluation of the risk and benefits of antiarrhythmic and ablation therapy.