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(Circulation. 1998;98:1594-1596.)
© 1998 American Heart Association, Inc.

Editorial

New Approaches to the Management of Atrial Fibrillation

The Role of the Atrial Defibrillator

Mark E. Josephson, MD

From the Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Beth Israel Deaconess Medical Center, Boston, Mass.

Correspondence to Mark E. Josephson, MD, Director, Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215.

Key Words: Editorials • fibrillation • defibrillation

Atrial fibrillation (AF) is the most common arrhythmia for which patients are hospitalized.¹ It imposes important morbidity and mortality on patients' lives, engendering enormous expenditures for its management. The frequency of AF increases with age (10% in patients >70 years old) and with the presence of congestive heart failure (up to 25%). Clinically, the appearance of AF may be associated with a variety of symptoms, including palpitations, heart failure, syncope, and chest pain, which occur primarily because of the heart rate. In addition, AF imposes an important risk of thromboembolism and the potential for the development of tachycardia-mediated cardiomyopathy. It has been estimated by some that nearly 40% of strokes in patients >70 years old may be a result of AF.² Whereas the financial burden imposed by AF itself is enormous, the added cost of caring for its sequelae, particularly cerebrovascular accidents, makes successful management of AF imperative.^{3 4}

Heretofore, the management of AF has been empirical and not very effective. Physicians are divided as to whether it is more important to maintain sinus rhythm or control the heart rate. The choice of therapy is dependent on the physician caring for the patient: internists, cardiologists, and electrophysiologists may choose different regimens.

Studies evaluating rate control by use of drugs singularly or in combination have shown that 50% of patients demonstrate adequate rate control with pharmacological therapy. Use of antiarrhythmic agents to prevent AF and maintain sinus rhythm is fraught with lack of efficacy, intolerance, and potentially lethal side effects. Although many . . . [Full Text of this Article]

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