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Pretreatment with Antiarrhythmic Drugs: Is It Useful to Avoid Immediate and Early Postcardioversion Recurrences?

  • G. L. Botto
  • M. Luzi
  • A. Sagone
Conference paper

Abstract

In patients with atrial fibrillation (AF), restoration of sinus rhythm (SR) may eliminate symptoms and prevent left ventricular dysfunction [1]. Electrical cardioversion is the most effective way to convert persistent AF to SR, since its efficacy is very close to 100% success in the biphasic shock era [2]. Unfortunately, because of the high recurrence rate, particularly in the first few hours after cardioversion, only 30% of patients maintain SR for 6 months or more without antiarrhythmic drug prophylaxis [3]. These findings provide the rationale for pretreatment and long-term prophylaxis with antiarrhythmic agents, although there are some concerns about the risk-benefit ratio of these drugs.

Keywords

Atrial Fibrillation Antiarrhythmic Drug Antiarrhythmic Agent Chronic Atrial Fibrillation Electrical Cardioversion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation (2001) J Am Coll Cardiol 38:1266 i-ixxCrossRefGoogle Scholar
  2. 2.
    Mittal S, Ayati S, Stein KM et al (2000) Transthoracic cardioversion of atrial fibrillation. Comparison of rectilinear biphasic versus damped sine wave monophasic shocks. Circulation 101:1282–1287PubMedCrossRefGoogle Scholar
  3. 3.
    Van Gelder IC, Crijins HJGM, Lie KI (1992) Characteristics of patients with chronic atrial fibrillation and prediction of successful DC electrical cardioversion. In: Kingma JH, Van Hemel NM, Lie KL (eds) Atrial fibrillation: a treatable disease? Kluwer Academic, Amsterdam, pp 67–86CrossRefGoogle Scholar
  4. 4.
    Oral H, Souza JJ, Michaud GF et al (1999) Facilitating transthoracic cardioversion of atrial fibrillation with ibutilide pretreatment. N Engl J Med 340:1849–54PubMedCrossRefGoogle Scholar
  5. 5.
    Timmermans C, Rodriguez LM, Smeets JLRM et al (1998) Immediate reinitiation of atrial fibrillation following internal defibrillation. J Cardiovasc Electrophysiol 9:122–128PubMedCrossRefGoogle Scholar
  6. 6.
    Bianconi L, Mennuni M, Lukic V et al (1996) Effects of oral propafenone administration before electrical cardioversion of chronic atrial fibrillation: a placebo-controlled study. J Am Coll Cardiol 28:700–706PubMedGoogle Scholar
  7. 7.
    Jais P, Haissaguerre M, Shah DC et al (1997) A focal source of atrial fibrillation treated by discrete radiofrequency ablation. Circulation 95:572–576PubMedCrossRefGoogle Scholar
  8. 8.
    Wijffels MCEF, Kirchhof CJHJ, Dorland R et al (1995) Atrial fibrillation begets atrial fibrillation: a study in awake chronically instrumented goats. Circulation 92:1954–1968PubMedCrossRefGoogle Scholar
  9. 9.
    Yu WC, Lee SH, Tai CT et al (1999) Reversal of atrial electrical remodeling following cardioversion of long standing atrial fibrillation in man. Cardiovasc Res 42:470–476PubMedCrossRefGoogle Scholar
  10. 10.
    Tieleman RG, De Langen CDJ, Van Gelder IC et al (1997) Verapamil reduces tachycar-dia-induced electrical remodeling of the atria. Circulation 95:1945–1953PubMedCrossRefGoogle Scholar
  11. 11.
    Tieleman RG, Van Gelder IC, Crijins HJGM et al (1998) Early recurrence of atrial fibrillation after electrical cardioversion: a result of fibrillation-induced electrical remodeling of the atria? J Am Coll Cardiol 31:167–173PubMedCrossRefGoogle Scholar
  12. 12.
    De Simone A, Stabile G, Vitale DF et al (1999) Pre-treatment with verapamil in patients with persistent or chronic atrial fibrillation who underwent electrical car-dioversion. J Am Coll Cardiol 34:810–814PubMedCrossRefGoogle Scholar
  13. 13.
    Botto GL, Belotti G, Cirò A et al, on behalf of the VERAF study group (2002) Verapamil in prevention of early recurrence of atrial fibrillation: final results of the VERAF study. Eur Heart J 23:660Google Scholar
  14. 14.
    Roy D, Talajic M, Dorian P et al, for the Canadian Trial of Atrial Fibrillation Investigators (2000) Amiodarone to prevent recurrence of atrial fibrillation. Canadian Trial of Atrial Fibrillation Investigators. N Engl J Med 342:913–920PubMedCrossRefGoogle Scholar
  15. 15.
    Capucci A, Villani GQ, Aschieri D et al (2000) Oral amiodarone increases the efficacy of DC cardioversion in restoration of sinus rhythm in patients with chronic atrial fibrillation. Eur Heart J 21:66–73PubMedCrossRefGoogle Scholar
  16. 16.
    Nakashima H, Kumagai K, Urata H et al (2000) Angiotensin II antagonist prevents electrical remodeling in atrial fibrillation. Circulation 101:2612–2617PubMedCrossRefGoogle Scholar
  17. 17.
    Madrid AH, Bueno MG, Rebollo JMG et al (2002) Use of ibesartan to maintain sinus rhythm in patients with long-lasting persistent atrial fibrillation. A prospective randomized study. Circulation 106:331–336Google Scholar

Copyright information

© Springer-Verlag Italia 2004

Authors and Affiliations

  • G. L. Botto
    • 1
  • M. Luzi
    • 1
  • A. Sagone
    • 1
  1. 1.Department of CardiologySant’ Anna HospitalComoItaly

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