Ventricular rate control in chronic atrial fibrillation during daily activity and programmed exercise: a crossover open-label study of five drug regimens

Farshi, Ramin; Kistner, Deborah; Sarma, J. S. M.; Longmate, Jeffrey; Singh, Bramah N.

doi:10.1016/s0735-1097(98)00561-0

Cited by 307 publications

(184 citation statements)

References 30 publications

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“…W krzyżowej próbie klinicznej w celu oceny mechanizmów działania, przeprowadzonej w grupie 47 pacjentów z HFrEF i AF, nie stwierdzono różnic pod względem częstości rytmu komór, ciśnienia tętniczego, dystansu chodu i LVEF między leczonymi karwedilolem a leczonymi digoksyną, choć podawanie beta-adrenolityku wiązało się z większym stężeniem peptydu natriuretycznego typu B, to podczas skojarzonego leczenia karwedilolem i digoksyną nastąpił wzrost LVEF, a odstawienie digoksyny spowodowało zmniejszenie LVEF [554]. Porównań z innymi lekami stosowanymi w celu kontroli częstości rytmu komór dokonano w małych, krótkoterminowych badaniach, w których nie stwierdzono różnic lub zaobserwowano jedyne marginalne różnice wydolności fizycznej, jakości życia lub LVEF w porównaniu ze stosowaniem digoksyny [526,[554][555][556][557][558]. Mniejsze dawki digoksyny (≤ 250 mg 1 ×/d.…”

Section: Naparstnicaunclassified

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,339

4,206

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Section: Naparstnicaunclassified

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,339

4,206

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“…This behavior is reminiscent of the effect seen with digoxin in humans, in whom rate control is adequate at rest but quickly lost during activity or adrenergic stimulation. 19 The interaction between adrenergic stimulation and wtGi overexpression suggests that the protein integrates normally into the G-protein receptorcoupled system. Obviously, further study is needed to inves- tigate the mechanism on a molecular and cellular level, but the response to wtGi gene transfer provides encouragement that the gene transfer effect is caused by normal processing and placement of the transgene protein.…”

Section: Combination Of Heart Failure and Arousal Overcome The Wtgi Ementioning

confidence: 99%

Inhibitory G Protein Overexpression Provides Physiologically Relevant Heart Rate Control in Persistent Atrial Fibrillation

et al. 2004

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Background-The need for new treatment strategies for cardiac arrhythmias has motivated our continuing development of gene therapeutic options. Previously, we reported a decreased heart rate in an acute model of atrial fibrillation after atrioventricular nodal gene transfer. Here, we expand those observations to persistent atrial fibrillation and severe heart failure. Methods and Results-After 3 weeks of atrial fibrillation, domestic swine received atrioventricular nodal gene transfer with adenoviruses encoding ␤-galactosidase (␤-gal), wild-type G␣ i2 (wtGi), or constitutively active mutant (cGi). Heart rates in awake, alert animals were not altered by ␤-gal or wtGi. cGi caused a sustained 15% to 25% decrease in heart rate. The wtGi effect became evident with sedation. A tachycardia-induced cardiomyopathy was present before gene transfer. In the ␤-gal group, cardiomyopathy worsened over time. In the wtGi group, the condition improved slightly, and in the cGi group, ejection fraction was near normal at the end of the study. TUNEL staining results corroborated this finding. Conclusions-cGi overexpression in the porcine atrioventricular node causes physiologically relevant heart rate control in persistent atrial fibrillation. These data advance the development of gene therapy as a potential treatment for common cardiac arrhythmias.

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“…It is generally accepted that a resting heart rate below 90 bpm is optimal, while on exertion the heart rate should not exceed 110 bpm in the sedentary patient or '200 minus age' in the ambulatory patient. 7 Beta-blockers are effective at controlling ventricular rate and are increasingly being used as first-line agents. Beta-blockers also offer some protection against recurrence following successful cardioversion (be it spontaneous, pharmacological or electrical) and are used as first-line prophylactic agents in paroxysmal AF.…”

Section: Rate Control In Atrial Fibrillationmentioning

confidence: 99%

Modern management of atrial fibrillation

2007

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-Atrial fibrillation (AF) continues to offer a management challenge to physicians. The incidence of this arrhythmia is rising and the cost to the healthcare system is vast. Much of this health burden relates to the high risk of stroke and thromboembolism associated with AF. This review covers common treatment strategies employed in AF management, discusses relevant drug therapy and the role of electrophysiology or surgery.KEY WORDS: antiarrhythmic drugs, atrial fibrillation, stroke, thromboembolic prophylaxis IntroductionAs the most common arrhythmia encountered in clinical practice and with rapidly evolving treatment strategies, atrial fibrillation (AF) continues to offer a management challenge to the physician. This emerging health epidemic is reflected by AF now consuming approximately 1% of NHS expenditure.Cross-sectional studies have shown that the prevalence and incidence of AF continues to surge, correlating in particular with the advancing age of Western populations. In those over 65, approximately 5% have AF, while in those aged over 80 years, this figure rises to 10%.This review focuses on management of AF with reference to the National Institute for Health and Clinical Excellence (NICE) evidence-based clinical guidelines published in June 2006. 1 In addition, the American College of Cardiology/American Heart Association/European Society of Cardiology consensus guidelines for the management of patients with AF have also now been updated. 2 Risk factors for atrial fibrillationMany risk factors for AF have been identified. As well as advancing age, there is a strong link with hypertension, ischaemic heart disease, structural/functional heart disease, valvular heart disease and hyperadrenergic states (such as thyrotoxicosis or illicit drug use), to name but a few. In some patients, alcohol excess may provide an adequate trigger for acute AF.In fact, the array of associations with AF is enormous (Box 1) and in part explains why a detailed knowledge of this condition is essential for both the generalist and specialist alike; not only will cardiologists frequently encounter AF, but so will colleagues in other specialties. Symptoms and presentationThe incidental finding of asymptomatic AF remains relatively common, often detected for example during preoperative assessment. Increasingly, though, AF is diagnosed during investigation for symptoms such as palpitations, dyspnoea, dizziness or syncope. This list is by no means exhaustive and it is increasingly recognised that AF contributes to or exacerbates numerous complaints, including lethargy, fatigue and anxiety. Additionally, it is important to remember that other conductive or atrioventricular nodal diseases may coexist with AF and in those who complain of syncopal episodes this should be considered as a co-diagnosis. Box 2 illustrates the most common symptoms reported in association with AF. ClassificationThe classification of AF has been through a period of change. Most are now agreed on a clinical classification system, based on the temporal pat...

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Ventricular rate control in chronic atrial fibrillation during daily activity and programmed exercise: a crossover open-label study of five drug regimens

Cited by 307 publications

References 30 publications

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Inhibitory G Protein Overexpression Provides Physiologically Relevant Heart Rate Control in Persistent Atrial Fibrillation

Modern management of atrial fibrillation

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