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(Circulation. 2002;106:1746.)
© 2002 American Heart Association, Inc.

Editorial

Selective Vagal Stimulation for Rate Control in Atrial Fibrillation

John P. DiMarco, MD, PhD

From the Cardiovascular Division, University of Virginia Health System, Charlottesville, Va.

Correspondence to John P. DiMarco, MD, PhD, Cardiovascular Division, University of Virginia Health System, PO Box 800158, Charlottesville, VA 22908. E-mail jdimarco@virginia.edu

Key Words: Editorials • atrioventricular node • fibrillation • pacemakers • vagus nerve

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Several recent randomized clinical trials comparing strategies based on control of ventricular rate versus those based on maintenance of sinus rhythm in elderly or high risk patients with atrial fibrillation have recently been reported.^1,2 Preliminary data from these trials suggest that the 2 strategies can produce roughly equivalent clinical outcomes. For individual patients, either approach may be appropriate because there appears to be no inherent advantage to a rhythm control strategy. These studies should cause doctors to look again at our techniques for achieving rate control in atrial fibrillation.

See p 1853

Pharmacological therapy has long been the primary technique for controlling ventricular rates in patients with atrial fibrillation. Cardiac glycosides, ß-adrenergic blockers, or calcium channels blockers are used, alone or frequently in combination, to prolong atrioventricular (AV) nodal refractoriness. Increased concealed conduction in the AV node results in moderation of the ventricular rate with conduction now occurring in an irregularly, irregular pattern. Although AV nodal blocking agents are usually considered to be safer and better tolerated than most membrane-active antiarrhythmic drugs, they do have some potential disadvantages. Many patients will require more than one agent. In patients with intermittent atrial fibrillation, excess bradycardia due to intrinsic or drug-induced sinus node dysfunction may be seen. Nocturnal bradycardia is common even if daytime or exercise rates are poorly controlled. Stress from an acute severe illness may make heart rate control difficult even in patients who normally have well controlled rates. Many patients cannot tolerate one or more of the agents for . . . [Full Text of this Article]

Related Article:

Ventricular Rate Control by Selective Vagal Stimulation Is Superior to Rhythm Regularization by Atrioventricular Nodal Ablation and Pacing During Atrial Fibrillation

Shaowei Zhuang, Youhua Zhang, Kent A. Mowrey, Jianbo Li, Tomotsugu Tabata, Don W. Wallick, Zoran B. Popovi, Richard A. Grimm, Andrea Natale, and Todor N. Mazgalev
Circulation 2002 106: 1853-1858. [Abstract] [Full Text]