Atrial Arrhythmias

The traditional approach to treatment of patients with sustained atrial arrhythmias— including atrial tachycardia, atrial flutter, and AF—involves initial attempts to slow the ventricular response to the tachycardia with AV-node blocking agents such as digoxin, calcium antagonists, or beta-blockers. Membrane-active antiarrhythmic agents are then added in an attempt to restore sinus rhythm. If the atrial arrhythmia persists after these measures have been instituted, direct current (DC) cardioversion may be considered. If the arrhythmia recurs, chronic antiarrhythmic therapy is recommended. Limitations of this approach include a high (>50%) incidence of arrhythmia recurrence as well as the expense, inconvenience, side effects, and proarrhythmic risks associated with antiarrhythmic agents (40-42).

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