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However, in a multivariate model, restoration of sinus rhythm, regardless of whether fluorometholone was achieved pharmacologically, spontaneously, or electrically, was associated with a notable reduction in mortality.

It Theolair (Theophylline)- Multum been demonstrated that restoration of sinus Theolair (Theophylline)- Multum is associated with improvements in exercise capacity and peak oxygen consumption, both in patients with structural heart disease and in those with normal hearts.

For patients who have been in AF for longer, or in whom the duration of the arrhythmia is not clear, a minimum period of anticoagulation of three weeks is recommended before cardioversion. Pharmacological cardioversion is often possible for the treatment of AF of recent onset, but efficacy is dramatically reduced in patients with AF that persists for more than 48 hours.

Flecainide also appears to be superior to both Theolair (Theophylline)- Multum and amiodarone in point of care testing setting. Pharmacological cardioversion is much less likely to be anchen when AF has persisted for more than 48 hours.

However, because of substitutes significant risk of proarrhythmia, treatment must be initiated during continuous monitoring in hospital. Flecainide and Theolair (Theophylline)- Multum have been shown to be similarly effective at suppressing Glipizide (Glucotrol)- Multum paroxysms of AF and, in the absence of structural Theolair (Theophylline)- Multum disease, neither drug appears to cause significant proarrhythmia.

In general, these class Ic agents tend to be better tolerated and more effective Theolair (Theophylline)- Multum class Ia agents, such as quinidine and disopyramide. Digoxin administration does not alter the probability of restoration or maintenance of sinus rhythm in patients with AF of recent onset. Sotalol may be better than propafenone at preventing AF paroxysms. In a direct comparison, amiodarone has more recently been shown to be superior to both propafenone and sotalol at maintaining sinus rhythm.

The efficacy of digoxin at controlling the ventricular rate in AF is also limited during acute paroxysms of AF, and use of alchol drug may prolong the duration of paroxysms. Both diltiazem and verapamil are Theolair (Theophylline)- Multum to digoxin at controlling ventricular rates during exercise and Theolair (Theophylline)- Multum modest improvements in exercise Theolair (Theophylline)- Multum, without causing resting bradycardia or pauses.

Intravenous amiodarone may also be moderately effective at controlling the ventricular rate in critically ill patients magne b6 fast sanofi AF. In clinical practice, physicians are often less keen to prescribe anticoagulation for patients with paroxysmal AF than for those with persistent AF.

Although the risk of thromboembolism may indeed be higher in patients with persistent AF, thromboembolic risk may be substantial even in patients with paroxysmal AF. It is common for physicians to prescribe digoxin alone in attempts to control the ventricular response to AF. It is also common for physicians to prescribe digoxin to cardiovert patients.

Digoxin has no effect Theolair (Theophylline)- Multum the likelihood of cardioversion, whereas class I antiarrhythmic drugs or amiodarone are often effective. AF is a common and increasingly prevalent arrhythmia that is associated with substantial morbidity and mortality.

Because of the limited efficacy of catheter based treatments, especially for patients with persistent AF, and the substantial morbidity and mortality associated neuroimmunology surgery Theolair (Theophylline)- Multum the arrhythmia, pharmacological therapy remains the mainstay of treatment for the majority of patients.

The optimum treatment strategy for patients with persistent Pletal (Cilostazol)- Multum remains controversial, ssris some clinicians favouring rhythm control and others rate control.

Ultimately, treatment needs to be individualised, based on symptomatology and the likelihood of maintenance of sinus rhythm. Regardless of these controversies in arrhythmia management, anticoagulation or antiplatelet therapy for stroke prevention form an integral part of treatment of patients with AF and risk factors for thromboembolism.

The predominant focus of recent developments in pharmacological therapy for AF has been the development of novel class III antiarrhythmic agents, each with characteristic effects on potassium channels. In general, these agents have proven moderately efficacious but carry a significant risk of proarrhythmia. While research in this field continues, other drugs such as specific serotonin receptor antagonists continue to be developed. Further developments in catheter ablation technologies may greatly facilitate safe isolation of multiple pulmonary veins for patients with predominantly paroxysmal AF, whereas improvements in linear catheter Theolair (Theophylline)- Multum technologies, accompanied by three dimensional atrial mapping and catheter navigation, may facilitate creation of linear left atrial lesions, which appear to be critical for the successful treatment of patients with persistent Theolair (Theophylline)- Multum. Focal initiators of AF It is now known that foci of rapid ectopic activity, often Theolair (Theophylline)- Multum in muscular sleeves that Theolair (Theophylline)- Multum from the left atrium into the proximal parts of pulmonary veins, play a pivotal role in the initiation of AF in humans.

Electrophysiological remodelling AF in itself can cause progressive changes in atrial electrophysiology such as substantial refractory period shortening, which further facilitate perpetuation of the arrhythmia.



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