Atrial fibrillation (AF) significantly increases the risk for stroke and mortality, and is the most common arrhythmia, affecting nearly 1% of the adult population. In the United States alone, 350,000 hospitalizations can be attributed to AF annually. In addition, incidence of AF continues to grow emphasizing the importance of identifying appropriate treatments that are safe, effective, and associated with improved clinical outcomes. Treatment recommendations from AF management guidelines are driven primarily by known safety profiles. The choice of treatment strategy and the specific therapy to use, however, are not without debate. Early landmark trials found that a rhythm-control strategy is just as important as a rate-control strategy, and that both impact outcomes similarly. Treatment decisions are contingent on a number of individual factors such as patient age, presence of structural heart disease, convenience of dosing, drug efficacy, and potential toxicity. The latter is of significant concern particularly since existing antiarrhythmic drugs (AADs) are known to increase the risk for drug-induced torsade de pointes and other life-threatening arrhythmias. Some AADs are also associated with serious side effects, eg, thyroid and pulmonary toxicity, and drug-drug interactions requiring close monitoring. Moreover, the adverse side effects from AADs significantly compromise quality of life and functional status. In addition, the efficacy of these agents is somewhat limited. There is a need to develop an AAD that effectively maintains sinus rhythm, but one in which that is associated with a favorable safety profile and one that actually improves clinical outcomes. Limitations of existing AADs have led to development of novel antiarrhythmic agents with both rhythm- and rate-controlling properties that are effective at maintaining sinus rhythm that avoid cardiac and extracardiac side effects commonly associated with available AADs, and that can improve clinical outcomes such as reducing the incidence of stroke, cardiovascular events, and hospitalizations.

md4arab

from medscape.com

authors

Peter R. Kowey, MD; Albert L. Waldo, MD; Jeremy N. Ruskin, MD