Non-Antiarrhythmic Drugs in Atrial Fibrillation
Non-Antiarrhythmic Drugs in Atrial Fibrillation
This article reviews current evidence of non-antiarrhythmic agents for the prevention and maintenance of sinus rhythm in patients with atrial fibrillation. These nontraditional agents include angiotensin coverting enzyme inhibitors, angiotensin receptor blockers, antiinflammatory agents, calcium channel blockers, and beta-blockers. The mechanisms of action and clinical trials regarding the effectiveness of these agents in atrial fibrillation prevention are reviewed.
In the long-term management of atrial fibrillation (AF), the strategy of rhythm control offers no long-term benefit in cardiac outcomes beyond that of symptom relief, and may be harmful. However, since relief of symptoms with improvement in quality of life is demanded by our patients, pursuit of sinus rhythm continues. Current antiarrhythmic agents used to maintain sinus rhythm have a multitude of adverse effects that can attenuate their value. Ablative therapy is not feasible for a sizable percentage of AF patients, so the search for safer pharmacological agents continues. This review focuses on non-antiarrhythmic agents in preventing AF, the proposed mechanism of effectiveness, and clinical trials that support their use (Fig. 1).
(Enlarge Image)
Figure 1.
Multiple pathways lead to atrial remodeling that predisposes the atria to atrial fibrillation. Numerous compounds can inhibit these pathways. (X = blocks the pathway).
Abstract and Introduction
Abstract
This article reviews current evidence of non-antiarrhythmic agents for the prevention and maintenance of sinus rhythm in patients with atrial fibrillation. These nontraditional agents include angiotensin coverting enzyme inhibitors, angiotensin receptor blockers, antiinflammatory agents, calcium channel blockers, and beta-blockers. The mechanisms of action and clinical trials regarding the effectiveness of these agents in atrial fibrillation prevention are reviewed.
Introduction
In the long-term management of atrial fibrillation (AF), the strategy of rhythm control offers no long-term benefit in cardiac outcomes beyond that of symptom relief, and may be harmful. However, since relief of symptoms with improvement in quality of life is demanded by our patients, pursuit of sinus rhythm continues. Current antiarrhythmic agents used to maintain sinus rhythm have a multitude of adverse effects that can attenuate their value. Ablative therapy is not feasible for a sizable percentage of AF patients, so the search for safer pharmacological agents continues. This review focuses on non-antiarrhythmic agents in preventing AF, the proposed mechanism of effectiveness, and clinical trials that support their use (Fig. 1).
(Enlarge Image)
Figure 1.
Multiple pathways lead to atrial remodeling that predisposes the atria to atrial fibrillation. Numerous compounds can inhibit these pathways. (X = blocks the pathway).
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