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Rate control in atrial fibrillation

Summary Control of the heart rate (rate control) is central to atrial fibrillation management, even for patients who ultimately require control of the rhythm. We review heart rate control in patients with atrial fibrillation, including the rationale for the intervention, patient selection, and the t... Full description

Journal Title: The Lancet (British edition) 2016, Vol.388 (10046), p.818-828
Main Author: Van Gelder, Isabelle C, Prof
Other Authors: Rienstra, Michiel, MD , Crijns, Harry J G M, Prof , Olshansky, Brian, Prof
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: England: Elsevier Ltd
ID: ISSN: 0140-6736
Link: https://www.ncbi.nlm.nih.gov/pubmed/27560277
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recordid: cdi_proquest_miscellaneous_1815697048
title: Rate control in atrial fibrillation
format: Article
creator:
  • Van Gelder, Isabelle C, Prof
  • Rienstra, Michiel, MD
  • Crijns, Harry J G M, Prof
  • Olshansky, Brian, Prof
subjects:
  • Ablation (Surgery)
  • Abridged Index Medicus
  • Adrenergic beta blockers
  • Adrenergic beta-Antagonists - therapeutic use
  • Age Factors
  • Amiodarone - therapeutic use
  • Anti-Arrhythmia Agents - therapeutic use
  • Atenolol - therapeutic use
  • Atrial fibrillation
  • Atrial Fibrillation - drug therapy
  • Atrial Fibrillation - physiopathology
  • Atrial Fibrillation - surgery
  • Atrial Fibrillation - therapy
  • ATRIOVENTRICULAR JUNCTION ABLATION
  • Atrioventricular Node - surgery
  • Bradycardia - therapy
  • Calcium Channel Blockers - therapeutic use
  • Cardiac arrhythmia
  • Cardiac patients
  • CARDIAC RESYNCHRONIZATION THERAPY
  • Catheter Ablation
  • Catheters
  • Digoxin
  • Digoxin - therapeutic use
  • Drug Therapy, Combination
  • Electrocardiography
  • Heart
  • Heart beat
  • Heart failure
  • Heart Failure - drug therapy
  • Heart Failure - physiopathology
  • Heart rate
  • Heart Rate - drug effects
  • HEART RHYTHM ASSOCIATION
  • Humans
  • Internal Medicine
  • LONG-TERM SURVIVAL
  • Mortality
  • Pacemaker, Artificial
  • Patient-Centered Care
  • Practice Guidelines as Topic
  • Randomized Controlled Trials as Topic
  • RATE CONTROL EFFICACY
  • REDUCED EJECTION FRACTION
  • Sotalol - therapeutic use
  • STRICT RATE CONTROL
  • Stroke
  • TASK-FORCE
  • TORSADE-DE-POINTES
  • VENTRICULAR RATE CONTROL
ispartof: The Lancet (British edition), 2016, Vol.388 (10046), p.818-828
description: Summary Control of the heart rate (rate control) is central to atrial fibrillation management, even for patients who ultimately require control of the rhythm. We review heart rate control in patients with atrial fibrillation, including the rationale for the intervention, patient selection, and the treatments available. The choice of rate control depends on the symptoms and clinical characteristics of the patient, but for all patients with atrial fibrillation, rate control is part of the management. Choice of drugs is patient-dependent. β blockers, alone or in combination with digoxin, or non-dihydropyridine calcium-channel blockers (not in heart failure) effectively lower the heart rate. Digoxin is least effective, but a reasonable choice for physically inactive patients aged 80 years or older, in whom other treatments are ineffective or are contraindicated, and as an additional drug to other rate-controlling drugs, especially in heart failure when instituted cautiously. Atrioventricular node ablation with pacemaker insertion for rate control should be used as an approach of last resort but is also an option early in the management of patients with atrial fibrillation treated with cardiac resynchronisation therapy. However, catheter ablation of atrial fibrillation should be considered before atrioventricular node ablation. Although rate control is a top priority and one of the first management issues for all patients with atrial fibrillation, many issues remain.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0140-6736
fulltext: fulltext
issn:
  • 0140-6736
  • 1474-547X
url: Link


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creatorcontribVan Gelder, Isabelle C, Prof ; Rienstra, Michiel, MD ; Crijns, Harry J G M, Prof ; Olshansky, Brian, Prof
descriptionSummary Control of the heart rate (rate control) is central to atrial fibrillation management, even for patients who ultimately require control of the rhythm. We review heart rate control in patients with atrial fibrillation, including the rationale for the intervention, patient selection, and the treatments available. The choice of rate control depends on the symptoms and clinical characteristics of the patient, but for all patients with atrial fibrillation, rate control is part of the management. Choice of drugs is patient-dependent. β blockers, alone or in combination with digoxin, or non-dihydropyridine calcium-channel blockers (not in heart failure) effectively lower the heart rate. Digoxin is least effective, but a reasonable choice for physically inactive patients aged 80 years or older, in whom other treatments are ineffective or are contraindicated, and as an additional drug to other rate-controlling drugs, especially in heart failure when instituted cautiously. Atrioventricular node ablation with pacemaker insertion for rate control should be used as an approach of last resort but is also an option early in the management of patients with atrial fibrillation treated with cardiac resynchronisation therapy. However, catheter ablation of atrial fibrillation should be considered before atrioventricular node ablation. Although rate control is a top priority and one of the first management issues for all patients with atrial fibrillation, many issues remain.
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subjectAblation (Surgery) ; Abridged Index Medicus ; Adrenergic beta blockers ; Adrenergic beta-Antagonists - therapeutic use ; Age Factors ; Amiodarone - therapeutic use ; Anti-Arrhythmia Agents - therapeutic use ; Atenolol - therapeutic use ; Atrial fibrillation ; Atrial Fibrillation - drug therapy ; Atrial Fibrillation - physiopathology ; Atrial Fibrillation - surgery ; Atrial Fibrillation - therapy ; ATRIOVENTRICULAR JUNCTION ABLATION ; Atrioventricular Node - surgery ; Bradycardia - therapy ; Calcium Channel Blockers - therapeutic use ; Cardiac arrhythmia ; Cardiac patients ; CARDIAC RESYNCHRONIZATION THERAPY ; Catheter Ablation ; Catheters ; Digoxin ; Digoxin - therapeutic use ; Drug Therapy, Combination ; Electrocardiography ; Heart ; Heart beat ; Heart failure ; Heart Failure - drug therapy ; Heart Failure - physiopathology ; Heart rate ; Heart Rate - drug effects ; HEART RHYTHM ASSOCIATION ; Humans ; Internal Medicine ; LONG-TERM SURVIVAL ; Mortality ; Pacemaker, Artificial ; Patient-Centered Care ; Practice Guidelines as Topic ; Randomized Controlled Trials as Topic ; RATE CONTROL EFFICACY ; REDUCED EJECTION FRACTION ; Sotalol - therapeutic use ; STRICT RATE CONTROL ; Stroke ; TASK-FORCE ; TORSADE-DE-POINTES ; VENTRICULAR RATE CONTROL
ispartofThe Lancet (British edition), 2016, Vol.388 (10046), p.818-828
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descriptionSummary Control of the heart rate (rate control) is central to atrial fibrillation management, even for patients who ultimately require control of the rhythm. We review heart rate control in patients with atrial fibrillation, including the rationale for the intervention, patient selection, and the treatments available. The choice of rate control depends on the symptoms and clinical characteristics of the patient, but for all patients with atrial fibrillation, rate control is part of the management. Choice of drugs is patient-dependent. β blockers, alone or in combination with digoxin, or non-dihydropyridine calcium-channel blockers (not in heart failure) effectively lower the heart rate. Digoxin is least effective, but a reasonable choice for physically inactive patients aged 80 years or older, in whom other treatments are ineffective or are contraindicated, and as an additional drug to other rate-controlling drugs, especially in heart failure when instituted cautiously. Atrioventricular node ablation with pacemaker insertion for rate control should be used as an approach of last resort but is also an option early in the management of patients with atrial fibrillation treated with cardiac resynchronisation therapy. However, catheter ablation of atrial fibrillation should be considered before atrioventricular node ablation. Although rate control is a top priority and one of the first management issues for all patients with atrial fibrillation, many issues remain.
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0Ablation (Surgery)
1Abridged Index Medicus
2Adrenergic beta blockers
3Adrenergic beta-Antagonists - therapeutic use
4Age Factors
5Amiodarone - therapeutic use
6Anti-Arrhythmia Agents - therapeutic use
7Atenolol - therapeutic use
8Atrial fibrillation
9Atrial Fibrillation - drug therapy
10Atrial Fibrillation - physiopathology
11Atrial Fibrillation - surgery
12Atrial Fibrillation - therapy
13ATRIOVENTRICULAR JUNCTION ABLATION
14Atrioventricular Node - surgery
15Bradycardia - therapy
16Calcium Channel Blockers - therapeutic use
17Cardiac arrhythmia
18Cardiac patients
19CARDIAC RESYNCHRONIZATION THERAPY
20Catheter Ablation
21Catheters
22Digoxin
23Digoxin - therapeutic use
24Drug Therapy, Combination
25Electrocardiography
26Heart
27Heart beat
28Heart failure
29Heart Failure - drug therapy
30Heart Failure - physiopathology
31Heart rate
32Heart Rate - drug effects
33HEART RHYTHM ASSOCIATION
34Humans
35Internal Medicine
36LONG-TERM SURVIVAL
37Mortality
38Pacemaker, Artificial
39Patient-Centered Care
40Practice Guidelines as Topic
41Randomized Controlled Trials as Topic
42RATE CONTROL EFFICACY
43REDUCED EJECTION FRACTION
44Sotalol - therapeutic use
45STRICT RATE CONTROL
46Stroke
47TASK-FORCE
48TORSADE-DE-POINTES
49VENTRICULAR RATE CONTROL
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titleRate control in atrial fibrillation
authorVan Gelder, Isabelle C, Prof ; Rienstra, Michiel, MD ; Crijns, Harry J G M, Prof ; Olshansky, Brian, Prof
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6Anti-Arrhythmia Agents - therapeutic use
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10Atrial Fibrillation - physiopathology
11Atrial Fibrillation - surgery
12Atrial Fibrillation - therapy
13ATRIOVENTRICULAR JUNCTION ABLATION
14Atrioventricular Node - surgery
15Bradycardia - therapy
16Calcium Channel Blockers - therapeutic use
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38Pacemaker, Artificial
39Patient-Centered Care
40Practice Guidelines as Topic
41Randomized Controlled Trials as Topic
42RATE CONTROL EFFICACY
43REDUCED EJECTION FRACTION
44Sotalol - therapeutic use
45STRICT RATE CONTROL
46Stroke
47TASK-FORCE
48TORSADE-DE-POINTES
49VENTRICULAR RATE CONTROL
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abstractSummary Control of the heart rate (rate control) is central to atrial fibrillation management, even for patients who ultimately require control of the rhythm. We review heart rate control in patients with atrial fibrillation, including the rationale for the intervention, patient selection, and the treatments available. The choice of rate control depends on the symptoms and clinical characteristics of the patient, but for all patients with atrial fibrillation, rate control is part of the management. Choice of drugs is patient-dependent. β blockers, alone or in combination with digoxin, or non-dihydropyridine calcium-channel blockers (not in heart failure) effectively lower the heart rate. Digoxin is least effective, but a reasonable choice for physically inactive patients aged 80 years or older, in whom other treatments are ineffective or are contraindicated, and as an additional drug to other rate-controlling drugs, especially in heart failure when instituted cautiously. Atrioventricular node ablation with pacemaker insertion for rate control should be used as an approach of last resort but is also an option early in the management of patients with atrial fibrillation treated with cardiac resynchronisation therapy. However, catheter ablation of atrial fibrillation should be considered before atrioventricular node ablation. Although rate control is a top priority and one of the first management issues for all patients with atrial fibrillation, many issues remain.
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pmid27560277
doi10.1016/S0140-6736(16)31258-2