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Atrial Fibrillation and Dilated Cardiomyopathy: Therapeutic Strategies When Sinus Rhythm Cannot be Maintained
Author(s) -
SAXON LESLIE A.
Publication year - 1997
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1997.tb03891.x
Subject(s) - medicine , sinus rhythm , dilated cardiomyopathy , atrial fibrillation , normal sinus rhythm , library science , gerontology , heart failure , computer science
Atrial fihrillation (AF) is present in 15%-30% of patients with dilated cardiomyopathy and moderate to advanced heart failure.^~^ This article will review the prevailing and investigational therapies for chronic AF occurring in the setting of dilated cardiomyopathy, highlight the dilemma of defining optimal ventricular rate control, and discuss the potential independent adverse effects of an irregular ventricular response to AF. Advances in the treatment of dilated heart failure with angiotensin-converting enzyme inhihitors in the presence of divu-etics and digitalis and avoidance of Type I antiarrhythmic drugs have resulted in equivalent survivals for heart failure patients with AF compared to those in normal sinus rhythm (SR).̂ ~^ In patients with AF, it is unknown if restoration of SR is superior to control of the ventricular response. Nonetheless, an attempt at restoration of SR with amiodarone therapy seems particularly warranted in the dilated heart failure population due to the hemodynamic henefits of preservation of atrial transport function, limitation of atrial enlargement, and the potential for lowering emholic risk.^"^'' A National Heart, Lung, and Blood Institute clinical study, the Atrial Fihrillation Follow-up Investigation of Rhythm Management (AFFIRM) Trial, which initiated patient enrollment in Novemher of 1995, was designed to determine if maintenance of normal SR with antiarrhythmic therapy improves survival in patients with AF of < 6 months' duration when compared to therapy that controls the ventricular rate response.