tailieunhanh - Amiodarone for Atrial Fibrillation

A 73-year-old man with stable coronary artery disease, hypertension, and chronic renal insufficiency presents with recurrent atrial fibrillation at 80 to 90 beats per minute. His symptoms include shortness of breath and fatigue. He has had atrial fibrillation twice in the past year; with each episode, electrical cardioversion resulted in marked improvement in his symptoms. His echocardiogram shows symmetric left ventricular hypertrophy with evidence of diastolic dysfunction. His medications include warfarin and metoprolol (25 mg twice daily). He is referred to a cardiologist, who recommends rhythm control with oral amiodarone | Amiodarone for Atrial Fibrillation Amiodarone for Atrial Fibrillation Peter Zimetbaum . This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit ofthis form of therapy follows. Major clinical studies the clinical use ofthis therapy and potential adverse effects are reviewed. Relevantformalguidelines if they exist are presented. The article ends with the author s clinical recommendations. A 73-year-old man with stable coronary artery disease hypertension and chronic renal insufficiency presents with recurrent atrial fibrillation at 80 to 90 beats per minute. His symptoms include shortness of breath and fatigue. He has had atrial fibrillation twice in the past year with each episode electrical cardioversion resulted in marked improvement in his symptoms. His echocardiogram shows symmetric left ventricular hypertrophy with evidence of diastolic dysfunction. His medications include warfarin and metoprolol 25 mg twice daily . He is referred to a cardiologist who recommends rhythm control with oral amiodarone. the clinical problem Atrial fibrillation is the most common cardiac arrhythmia seen in clinical practice. It currently affects more than 2 million Americans with a projected increase to 10 million by the year Atrial fibrillation may occur in a paroxysmal self-remitting pattern or may persist unless cardioversion is performed. It is rarely if ever a one-time event but can be expected to recur unpredictably. Symptoms including palpitations dyspnea fatigue and chest pain are present in 85 of patients at the onset of the arrhythmia but often dissipate with rate- or rhythm-control The morbidity and mortality associated with this disorder relate to these symptoms as well as to hemodynamic and thromboembolic complications. Strategies to maintain sinus rhythm have not been shown to reduce total mortality or the risk of stroke but have been shown to .