Management of Atrial Fibrillation: Review of the Evidence for the Role of Pharmacologic Therapy, Electrical Cardioversion, and Echocardiography

Robert L. McNamara, Leonardo Tamariz, Jodi B. Segal, Eric B. Bass

Research output: Contribution to journalArticle

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Abstract

Purpose: This review summarizes the available evidence regarding the efficacy of medications used for ventricular rate control, stroke prevention, acute conversion, and maintenance of sinus rhythm, as well as the efficacy of electrical cardioversion and the use of echocardiography in patients with atrial fibrillation. Data Sources: The Cochrane Collaboration's database of controlled clinical trials and MEDLINE. Study Selection: Primarily randomized, controlled trials of medications. Data Extraction: Paired reviewers obtained data on efficacy and safety. Strength of evidence was assessed. Data Synthesis: Recent clinical trial results showed that most patients with atrial fibrillation have similar outcomes with strategies for controlling ventricular rate compared with strategies for restoring sinus rhythm. For efficacy of primary stroke prevention, compared with placebo, evidence was strong for warfarin and suggestive for aspirin. The evidence for an increased risk for major bleeding was suggestive for warfarin and inconclusive for aspirin. For ventricular rate control, verapamil, diltiazem, atenolol, and metoprolol were qualitatively superior to digoxin and placebo, particularly during exercise. For efficacy of acute conversion, compared with placebo, evidence was strong for ibutilide, flecainide, dofetilide, propafenone, amiodarone, and quinidine. For efficacy of maintenance of sinus rhythm after conversion from atrial fibrillation, evidence was strong for amiodarone, propafenone, disopyramide, and sotalol. Echocardiography was found to be useful in estimating risk for thromboembolism and potentially useful in estimating likelihood of successful cardioversion and maintenance. Conclusions: For several key questions in the pharmacologic management of atrial fibrillation, strong evidence exists to support 1 or more treatment options.

Original languageEnglish
Pages (from-to)1018-1033
Number of pages16
JournalAnnals of Internal Medicine
Volume139
Issue number12
StatePublished - Dec 16 2003
Externally publishedYes

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Electric Countershock
Atrial Fibrillation
Echocardiography
Propafenone
Amiodarone
Placebos
Maintenance
Warfarin
Aspirin
Stroke
Flecainide
Disopyramide
Sotalol
Metoprolol
Quinidine
Atenolol
Diltiazem
Information Storage and Retrieval
Thromboembolism
Digoxin

ASJC Scopus subject areas

  • Medicine(all)

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Management of Atrial Fibrillation : Review of the Evidence for the Role of Pharmacologic Therapy, Electrical Cardioversion, and Echocardiography. / McNamara, Robert L.; Tamariz, Leonardo; Segal, Jodi B.; Bass, Eric B.

In: Annals of Internal Medicine, Vol. 139, No. 12, 16.12.2003, p. 1018-1033.

Research output: Contribution to journalArticle

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