Drug Prevention of Paroxysmal Atrial Fibrillation, When and How?
Paroxysmal atrial fibrillation is self-limiting since — by definition  — attacks stop spontaneously, while only prolonged symptomatic episodes require drug intervention (Table 1). Despite being episodic and self-limiting, paroxysmal atrial fibrillation is a chronic disease: sooner or later after the first clinically significant attack most patients will experience a second one, even while using prophylactic antiarrhythmic drugs . Therefore, drug intervention may at best reduce the number of attacks over time or postpone recurrences. Thus the primary aim of treatment is to improve quality of life rather than to simply suppress the arrhythmia. In this respect patient counseling is highly important. Patients should know that recurrences are a normal phenomenon even when using drugs, and that a breakthrough arrhythmia is not necessarily a sign of drug inefficacy. Consequently, a given drug should be replaced or non-pharmacologic treatment considered only if breakthrough arrhythmias or side effects are not tolerated.
KeywordsAtrial Fibrillation Paroxysmal Atrial Fibrillation Chronic Atrial Fibrillation Drug Prevention Sick Sinus Syndrome
Unable to display preview. Download preview PDF.
- 3.Godtfredsen J (1982) Atrial fibrillation: course and prognosis. A follow-up study of 1212 cases. In: Kulbertus HE, Olsson SB, Schlepper M (eds) Atrial fibrillation. Lindgren and Söner, Mölndal, pp 134–145Google Scholar
- 5.Van Gelder IC, Crijns HJGM, Blanksma PK, Landsman, MLJ, Posma JL, Van Den Berg MP, Meijler FL, Lie KI (1993) Time course of hemodynamic changes and improvement of exercise tolerance after cardioversion of chronic atrial fibrillation unassociated with cardiac valve disease. Am J Cardiol 72: 560–566PubMedCrossRefGoogle Scholar
- 6.Wijffels MCEF, Kirchhof CJHJ, Dorland R, Allessie MA (1995) Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation 92: 1954–1968Google Scholar
- 8.Jenkins LS, Ellenbogen K, Kay N, Giudici M, Jensen N, Martin R, Bubien R (1995) Quality of life in patients with symptomatic atrial fibrillation. Circulation 92(I): 490 (abstr)Google Scholar
- 10.Brignole M, Gianfranchi L, Menozzi C, Bottoni N, Bollini R, Lolli G, Oddone D, Gaggioli G (1994) Influence of atrioventricular junction radiofrequency ablation in patients with chronic atrial fibrillation and flutter on quality of life and cardiac performance. Am J Cardiol 74: 242–246PubMedCrossRefGoogle Scholar
- 13.Coplen SE, Antman EM, Berlin JA, Hewitt P, Chalmers TC (1990) Efficacy and safety of quinidine therapy for maintenance of sinus rhythm after cardioversion. A meta-analysis of randomized control trials. Circulation 82: 1106–1116Google Scholar
- 16.UK Propafenone PSVT Study Group (1995) A randomized, placebo-controlled trial of propafenone in the prophylaxis of paroxysmal supraventricular tachycardia and paroxysmal atrial fibrillation. Circulation 92: 2550–2557Google Scholar