Efficacy and Safety of Pharmacological Options for Rate Control in Atrial Fibrillation
Earnest Alexander PharmD
Earnest Alexander PharmD; Department Editors
Katie O'Brien PharmD
Lindsay Patel PharmD, BCPS
Gregory M. Susla PharmD; Department Editors

$7.95 		AACN Advanced Critical Care
June 2012 
Volume 23  Number 2
Pages 120 - 125
 
  PDF Version Available!

ABSTRACT
Atrial fibrillation (AF) is the most common arrhythmia, and its prevalence will continue to increase as people age. Approximately 3 million people in the United States currently have AF, with an estimated 7.5 million people by the year 2050.1 Atrial fibrillation is characterized by uncoordinated atrial firing, which disrupts the normal sinus rhythm of the heart. The arrhythmia can be classified by the occurrence of its symptoms, such as first episode, recurrent, paroxysmal, and persistent. When AF is not controlled, the symptoms may be severe and interrupt a patient's activities of daily life. Mortality rates of patients with AF are double those of patients in normal sinus rhythm.2 Furthermore, AF may require urgent treatment to prevent or correct events such as stroke, thromboembolism, and hemodynamic compromise. Although the underlying cause of AF is unknown, several disorders contribute to its development. Hypertension, diabetes, and congestive heart failure are just a few causes that can contribute to the clinical risk factors for AF. On the basis of the potential negative clinical outcomes, health care providers must understand the role of pharmacological management strategies that can improve quality of life and care in patients with AF.When a patient is diagnosed with persistent or permanent AF, pharmacological management of either heart rate or rhythm is the mainstay of treatment. Under normal conditions, cardiac output is directly related to heart rate and stroke volume. Increases in heart rate and/or stroke volume generally result in a proportional increase in cardiac output. During AF, the atria of the heart quiver, resulting in diminished atrial filling, decreased stroke volume, and decreased cardiac output. During AF with rapid ventricular response (RVR), cardiac output is further decreased by both quivering atria and fast ventricle contraction because of reduced atrial and ventricular filling. Pharmacological management strategies are based on improving

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