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Chang MS, Gibson JK, Ellenbogen KA, Although class III agents are useful as adjuncts to electric cardioversion and are effective in maintaining sinus rhythm, only ibutilide is useful for acute cardioversion. Thus, cardioversion is used only in cases of acute and chronic persistent atrial fibrillation and not in cases previously demonstrated to be refractory.The electrophysiologic mechanism for atrial fibrillation appears to be multiple wavelets of reentry.Several pathophysiologic factors favor the initiation and maintenance of atrial fibrillation Increased sympathetic activity and increased vagal tone decrease the atrial refractory period, as does thyrotoxicosis. Douglas PS. Falk RH, 0000073856 00000 n Rius T, External direct current (DC) cardioversion is the most effective means of converting atrial fibrillation to sinus rhythm. Comparison of intravenous ibutilide versus procainamide for the rapid termination of atrial fibrillation or flutter. Access This ArticleJOSEPH T. DELL'ORFANO, M.D., is a postdoctoral fellow in cardiac electrophysiology at the Milton S. Hershey Medical Center, Hershey, Pa. Boriani G, A randomized, double-blinded trial. Electrophysiology, 17th Annual Scientific Sessions; 1996 May 15–18; Seattle.

Copyright © 1998 by the American Academy of Family Physicians.Copyright © 2020 American Academy of Family Physicians.

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Unfortunately, antiarrhythmic medications also decrease conduction velocity, therefore favoring atrial fibrillation, which may account for the mixed efficacy of antiarrhythmic medications in maintaining sinus rhythm.If the decision is made for a patient to undergo cardioversion, the procedure should be performed as close to the onset of arrhythmia as possible. If toxicity is suspected, a plasma level is required prior to giving additional digoxin. Patients who are clinically unstable should undergo immediate cardioversion. Clemo HF, Savage DD, Chiang HT, Until the results of several large-scale randomized clinical trials are available, the decision to choose cardioversion or maintenance of sinus rhythm must be individualized, based on relief of symptoms and reduction of the morbidity and mortality associated with atrial fibrillation.Atrial fibrillation is the most common sustained arrhythmia encountered in primary care practice. Proarrhythmia in patients treated for atrial fibrillation or flutter.

This can be accomplished using calcium channel blockers such as diltiazem (Cardizem) or verapamil (Calan, Isoptin), beta blockers such as metoprolol (Lopressor) or esmolol (Brevibloc), or digoxin (Lanoxin).Intravenous calcium channel blockers and beta blockers have the advantage of rapid onset of action Digoxin is not effective in converting atrial fibrillation to sinus rhythm. et al. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Unlike the class I agents, amiodarone (Cordarone) does not appear to be more effective than placebo in converting recent-onset atrial fibrillation to sinus rhythm, although patients who are treated with amiodarone tend to have a more controlled heart rate.Sotalol (Betapace) also is not useful for the acute termination of atrial fibrillation, probably because it tends to prolong atrial refractoriness more at a slow rate than during tachycardia.It should be noted that sotalol and amiodarone slow conduction and prolong refractoriness in the atrioventricular node and thus can control ventricular response to atrial fibrillation.Ibutilide (Corvert) is a new intravenous class III antiarrhythmic agent. Sarter BH, �����k{�I����&���ט�,?���E�y�_�I��#_V�}�N'�TX(V�����1^�l K���"��(k�M�������f/���9 q^��4�g&6��Xu�������`�/N���^�����Tbwt�z��f���Yo3����z�����IU��m`��>�?��u�T�0I��V�Wo�.#�n����D�Ş�-Up9x�BRؘ5f-�t"J�n��WMu�*�P�bQ�p���V�x#��Z��Ĩ�ra���-��~~�3l�~�H�Z�- �H�:̀� ~�w Comparison of sotalol with digoxin-quinidine for conversion of acute atrial fibrillation to sinus rhythm (the Sotalol-Digoxin-Quinidine Trial). Rautaharju PM.

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