Pharmacological cardioversion for atrial fibrillation and flutter

Pharmacological treatment of persistent atrial fibrillation in the older adult: Evidence-based practice

“…The authors suggested that the trend toward a reduction of thromboembolic stroke in patients in the rate‐control group was probably related to the continuation of anticoagulant therapy for a longer period of time than those patients on rhythm‐control agents. Cordina and Mead (2006) also noted a difference in stroke outcomes when data from the AFFIRM and PIAF studies were pooled with the RACE and STAF studies. The incidence of stroke in the combined rhythm‐control groups was 6.3% compared with a 4.7% incidence in the combined rate‐control groups.…”

“…Cordina and Mead (2006) conclude with a major recommendation to use anticoagulant therapy in all patients with AF, even those who have converted to sinus rhythm. The practice of discontinuing warfarin 4 weeks after converting to sinus rhythm was described as potentially life‐threatening as the risk of stroke appears to remain high irrespective of the cardiac rhythm.…”

“…What appears most important is that all patients with a history of AF should receive life‐long antithrombotic therapy, even if they have achieved sinus rhythm for a prolonged period of time (Cordina & Mead, 2006; Hohnloser et al, 2008; Korantzopoulos et al, 2005; Testa et al, 2005). As noted by Waldo (2006) there have been no studies to suggest that antiarrhythmic drug therapy reduces the need for anticoagulation therapy.…”

Pharmacological treatment of persistent atrial fibrillation in the older adult: Evidence-based practice

“…The authors suggested that the trend toward a reduction of thromboembolic stroke in patients in the rate‐control group was probably related to the continuation of anticoagulant therapy for a longer period of time than those patients on rhythm‐control agents. Cordina and Mead (2006) also noted a difference in stroke outcomes when data from the AFFIRM and PIAF studies were pooled with the RACE and STAF studies. The incidence of stroke in the combined rhythm‐control groups was 6.3% compared with a 4.7% incidence in the combined rate‐control groups.…”

“…Cordina and Mead (2006) conclude with a major recommendation to use anticoagulant therapy in all patients with AF, even those who have converted to sinus rhythm. The practice of discontinuing warfarin 4 weeks after converting to sinus rhythm was described as potentially life‐threatening as the risk of stroke appears to remain high irrespective of the cardiac rhythm.…”

“…What appears most important is that all patients with a history of AF should receive life‐long antithrombotic therapy, even if they have achieved sinus rhythm for a prolonged period of time (Cordina & Mead, 2006; Hohnloser et al, 2008; Korantzopoulos et al, 2005; Testa et al, 2005). As noted by Waldo (2006) there have been no studies to suggest that antiarrhythmic drug therapy reduces the need for anticoagulation therapy.…”

Pharmacologic Rate versus Rhythm‐Control Strategies in Atrial Fibrillation: An Updated Comprehensive Review and Meta‐Analysis

“…This is indicative of a greater cost associated with adoption of a rhythm‐control strategy directly as well as indirectly in the form of greater incidence of complications like nosocomial infection in patients with inpatient therapy. Some of the rehospitalization rates have been attributed to necessity for rhythm conversion by cardioversion in a monitored setting; however, also likely are complications like dysrrhythmias from the antiarrhythmics used for the maintenance of sinus rhythm . However, a note of caution appears prudent that rehospitalization rates in the included studies are confounded by the requirement to restore and maintain sinus rhythm by protocol in the rhythm‐control arm of the various studies, as well as by the open label nature of the studies.…”

Addressing the management of atrial fibrillation – a systematic review of the role of dronedarone

“……”

Pharmacological treatment of persistent atrial fibrillation in the older adult: Evidence-based practice

“…The authors suggested that the trend toward a reduction of thromboembolic stroke in patients in the rate‐control group was probably related to the continuation of anticoagulant therapy for a longer period of time than those patients on rhythm‐control agents. Cordina and Mead (2006) also noted a difference in stroke outcomes when data from the AFFIRM and PIAF studies were pooled with the RACE and STAF studies. The incidence of stroke in the combined rhythm‐control groups was 6.3% compared with a 4.7% incidence in the combined rate‐control groups.…”

“…Cordina and Mead (2006) conclude with a major recommendation to use anticoagulant therapy in all patients with AF, even those who have converted to sinus rhythm. The practice of discontinuing warfarin 4 weeks after converting to sinus rhythm was described as potentially life‐threatening as the risk of stroke appears to remain high irrespective of the cardiac rhythm.…”

“…What appears most important is that all patients with a history of AF should receive life‐long antithrombotic therapy, even if they have achieved sinus rhythm for a prolonged period of time (Cordina & Mead, 2006; Hohnloser et al, 2008; Korantzopoulos et al, 2005; Testa et al, 2005). As noted by Waldo (2006) there have been no studies to suggest that antiarrhythmic drug therapy reduces the need for anticoagulation therapy.…”

Pharmacologic Rate versus Rhythm‐Control Strategies in Atrial Fibrillation: An Updated Comprehensive Review and Meta‐Analysis

“…This is indicative of a greater cost associated with adoption of a rhythm‐control strategy directly as well as indirectly in the form of greater incidence of complications like nosocomial infection in patients with inpatient therapy. Some of the rehospitalization rates have been attributed to necessity for rhythm conversion by cardioversion in a monitored setting; however, also likely are complications like dysrrhythmias from the antiarrhythmics used for the maintenance of sinus rhythm . However, a note of caution appears prudent that rehospitalization rates in the included studies are confounded by the requirement to restore and maintain sinus rhythm by protocol in the rhythm‐control arm of the various studies, as well as by the open label nature of the studies.…”

Addressing the management of atrial fibrillation – a systematic review of the role of dronedarone

“……”

Pharmacological treatment of persistent atrial fibrillation in the older adult: Evidence-based practice

“…The authors suggested that the trend toward a reduction of thromboembolic stroke in patients in the rate‐control group was probably related to the continuation of anticoagulant therapy for a longer period of time than those patients on rhythm‐control agents. Cordina and Mead (2006) also noted a difference in stroke outcomes when data from the AFFIRM and PIAF studies were pooled with the RACE and STAF studies. The incidence of stroke in the combined rhythm‐control groups was 6.3% compared with a 4.7% incidence in the combined rate‐control groups.…”

“…Cordina and Mead (2006) conclude with a major recommendation to use anticoagulant therapy in all patients with AF, even those who have converted to sinus rhythm. The practice of discontinuing warfarin 4 weeks after converting to sinus rhythm was described as potentially life‐threatening as the risk of stroke appears to remain high irrespective of the cardiac rhythm.…”

“…What appears most important is that all patients with a history of AF should receive life‐long antithrombotic therapy, even if they have achieved sinus rhythm for a prolonged period of time (Cordina & Mead, 2006; Hohnloser et al, 2008; Korantzopoulos et al, 2005; Testa et al, 2005). As noted by Waldo (2006) there have been no studies to suggest that antiarrhythmic drug therapy reduces the need for anticoagulation therapy.…”

Pharmacologic Rate versus Rhythm‐Control Strategies in Atrial Fibrillation: An Updated Comprehensive Review and Meta‐Analysis

“…This is indicative of a greater cost associated with adoption of a rhythm‐control strategy directly as well as indirectly in the form of greater incidence of complications like nosocomial infection in patients with inpatient therapy. Some of the rehospitalization rates have been attributed to necessity for rhythm conversion by cardioversion in a monitored setting; however, also likely are complications like dysrrhythmias from the antiarrhythmics used for the maintenance of sinus rhythm . However, a note of caution appears prudent that rehospitalization rates in the included studies are confounded by the requirement to restore and maintain sinus rhythm by protocol in the rhythm‐control arm of the various studies, as well as by the open label nature of the studies.…”

Addressing the management of atrial fibrillation – a systematic review of the role of dronedarone

“……”