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HEALTH & SCIENCENew guidelines for treating atrial fibrillation focus on rate over rhythmA revised approach to the common heart condition triggers debate on how much emphasis to place on establishing normal rhythm.By Susan J. Landers, AMNews staff. Jan. 12, 2004. Washington -- Focus treatment on a patient's heart rate rather than heart rhythm in controlling atrial fibrillation, according to new guidelines released Dec. 16 by the American Academy of Family Physicians and the American College of Physicians. "The generally accepted practice has been to do everything we can to get patients back into sinus rhythm and to try to keep them there," said Michael LeFevre, MD, MSPH, co-chair of the Joint AAFP-ACP Panel on Atrial Fibrillation. However, the latest research shows that the preferred approach for most of these patients should be to focus on control of heart rate rather than attempting to restore sinus rhythm, said Dr. LeFevre. "Controlling rhythm was not better than controlling rate in reducing complications and death, and the side effects of medications to keep patients in normal rhythm may be greater than their benefits," he said. Atrial fibrillation, the most common heart arrhythmia, is found in about 2 million people. Standard treatments have attempted to convert the heart to normal rhythm, either with medications, often used long term, or by electricity. While it's rarely fatal, if uncontrolled, atrial fibrillation can cause strokes when blood clots formed in the atria travel to the brain. The new guidelines, which were published in the Dec. 16, 2003, Annals of Internal Medicine, also recommend the use of warfarin to help prevent strokes. A strategy of using blood thinners has been recommended in the past, though all would caution against using such medications in patients who have an increased risk of bleeding. [...]Full text of AMNews content is available to AMA members and paid subscribers.
Copyright 2004 American Medical Association. All rights reserved.
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