Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Drugs
Published in: Drugs 7/2009

01-05-2009 | Leading Article

Novel Approaches for Pharmacological Management of Atrial Fibrillation

Authors: Dr. Joachim R. Ehrlich, Stanley Nattel

Published in: Drugs | Issue 7/2009

Login to get access

Abstract

In the light of the progressively increasing prevalence of atrial fibrillation (AF), medical awareness of the need to develop improved therapeutic approaches for the arrhythmia has also risen over the last decade. AF reduces quality of life and is associated with increased morbidity and mortality. Despite several setbacks as a result of negative results from rhythm control trials, the potential advantages of sinus-rhythm (SR) maintenance have motivated continued efforts to design novel pharmacological options aiming to terminate AF and prevent its recurrence, with a hope that optimized medical therapy will improve outcomes in AF patients.
Pathophysiologically, AF is associated with electrical and structural changes in the atria, which increase the propensity to arrhythmia perpetuation but may eventually allow for new modalities for therapeutic intervention.
Antiarrhythmic drug therapy has traditionally targeted ionic currents that modulate excitability and/or repolarization of cardiac myocytes. Despite efficacious suppression of ventricular and supraventricular arrhythmias, traditional antiarrhythmic drugs present problematic risks of pro-arrhythmia, potentially leading to excess mortality in the case of Na+-channel blockers or IKr (IKr = the rapid component of the delayed rectifier potassium current) blockers. New anti-AF agents in development do not fit well into the classical Singh and Vaughan-Williams formulation, and are broadly divided into ‘atrial-selective compounds’ and ‘multiple-channel blockers’.
The prototypic multiple-channel blocker amiodarone is the most efficient presently available compound for SR maintenance, but the drug has extra-cardiac adverse effects and complex pharmacokinetics that limit widespread application. The other available drugs are not nearly as efficient for SR maintenance and have a greater risk of proarrhythmia than amiodarone.
Two new antiarrhythmic drugs are on the cusp of introduction into clinical practice. Vernakalant affects several atrially expressed ion channels and has rapid unbinding Na+-channel blocking action along with promising efficacy for AF conversion to SR. Dronedarone is an amiodarone derivative with an electrophysiological profile similar to its predecessor but lacking most amiodarone-associated adverse effects. Furthermore, dronedarone has shown benefits for important clinical endpoints, including cardiovascular mortality in specific AF populations, the first AF-suppressing drug to do so in prospective randomized clinical trials.
Agents that modulate non-ionic current targets (termed ‘upstream’ therapies) may help to modify the substrate for AF maintenance. Among these, drugs such as angiotensin II type 1 (AT1) receptor antagonists, im-munosuppressive agents or HMG-CoA reductase inhibitors (statins) deserve mention. Finally, drugs that block atrial-selective ion-channel targets such as the ultra-rapid delayed rectifier current (IKur) and the acetylcholine-regulated K+-current (Ikach) are presently in development.
The introduction of novel antiarrhythmic agents for the management of AF may eventually improve patient outcomes. The potential value of a variety of other novel therapeutic options is currently under active investigation.
Literature
1.
Miyasaka Y, Barnes ME, Gersh BJ, et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation 2006; 114(2): 119–25PubMedCrossRef
2.
Ehrlich JR, Nattel S, Hohnloser SH. Atrial fibrillation and congestive heart failure: specific considerations at the intersection of two common and important cardiac disease sets. J Cardiovasc Electrophysiol 2002; 13(4): 399–405PubMedCrossRef
3.
Ehrlich JR, Hohnloser SH, Nattel S. Role of angiotensin system and effects of its inhibition in atrial fibrillation: clinical and experimental evidence. Eur Heart J 2006; 27(5): 512–8PubMedCrossRef
4.
Nattel S, Maguy A, Le Bouter S, et al. Arrhythmogenic ion-channel remodeling in the heart: heart failure, myocardial infarction, and atrial fibrillation. Physiol Rev 2007; 87(2): 425–56PubMedCrossRef
5.
Haissaguerre M, Jais P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins. N Engl J Med 1998; 339: 659–66PubMedCrossRef
6.
Vest JA, Wehrens XH, Reiken SR, et al. Defective cardiac ryanodine receptor regulation during atrial fibrillation. Circulation 2005; 111(16): 2025–32PubMedCrossRef
7.
Yeh YH, Wakili R, Qi XY, et al. Calcium handling abnormalities underlying atrial arrhythmogenesis and contractile dysfunction in dogs with congestive heart failure. Circulation Arrhythmia Electrophysiol 2008; 1: 93–102CrossRef
8.
Wijffels MC, Kirchhof CJ, Dorland R, et al. Atrial fibrillation begets atrial fibrillation: a study in awake chronically instrumented goats. Circulation 1995; 92: 1954–68PubMedCrossRef
9.
10.
Qi XY, Yeh YH, Xiao L, et al. Cellular signaling underlying atrial tachycardia remodeling of L-type calcium current. Circ Res 2008; 103(8): 845–54PubMedCrossRef
11.
Cha TJ, Ehrlich JR, Chartier D, et al. Kir3-based inward rectifier potassium current: potential role in atrial tachycardia remodeling effects on atrial repolarization and arrhythmias. Circulation 2006; 113(14): 1730–7PubMedCrossRef
12.
Pandit SV, Berenfeld O, Anumonwo JM, et al. Ionic determinants of functional reentry in a 2-D model of human atrial cells during simulated chronic atrial fibrillation. Biophys J 2005; 88(6): 3806–21PubMedCrossRef
13.
Atienza F, Almendral J, Moreno J, et al. Activation of inward rectifier potassium channels accelerates atrial fibrillation in humans: evidence for a reentrant mechanism. Circulation 2006; 114(23): 2434–42PubMedCrossRef
14.
Jalife J, Berenfeld O, Mansour M. Mother rotors and fibrillatory conduction: a mechanism of atrial fibrillation. Cardiovasc Res 2002; 54(2): 204–16PubMedCrossRef
15.
Comtois P, Kneller J, Nattel S. Of circles and spirals: bridging the gap between the leading circle and spiral wave concepts of cardiac reentry. Europace 2005; 7 Suppl. 2: 10–20PubMedCrossRef
16.
Fareh S, Villemaire C, Nattel S. Importance of refractoriness heterogeneity in the enhanced vulnerability to atrial fibrillation induction caused by tachycardia-induced electrical remodeling. Circulation 1998; 98: 2202–9PubMedCrossRef
17.
Cha TJ, Ehrlich JR, Zhang L, et al. Dissociation between ionic remodeling and ability to sustain atrial fibrillation during recovery from experimental congestive heart failure. Circulation 2004; 109(3): 412–8PubMedCrossRef
18.
Allessie MA, Bonke FI, Schopman FJ. Circus movement in rabbit atrial muscle as a mechanism of tachycardia, III: the ‘leading circle’ concept — a new model of circus movement in cardiac tissue without the involvement of an anatomical obstacle. Circ Res 1977; 41(1): 9–18PubMedCrossRef
19.
Singh BN, Vaughan Williams EM. A third class of anti-arrhythmic action: effects on atrial and ventricular intra-cellular potentials, and other pharmacological actions on cardiac muscle, of MJ 1999 and AH 3474. Br J Pharmacol 1970; 39(4): 675–87PubMedCrossRef
20.
Nattel S. Antiarrhythmic drug classifications: a critical appraisal of their history, present status, and clinical relevance. Drugs 1991; 41: 672–701PubMedCrossRef
21.
Allessie MA, Bonke FI, Schopman FJ. Circus movement in rabbit atrial muscle as a mechanism of tachycardia, II: the role of nonuniform recovery of excitability in the occurrence of unidirectional block, as studied with multiple microelectrodes. Circ Res 1976; 39(2): 168–77PubMedCrossRef
22.
Rensma PL, Allessie MA, Lammers WJ, et al. Length of excitation wave and susceptibility to reentrant atrial arrhythmias in normal conscious dogs. Circ Res 1988; 62(2): 395–410PubMedCrossRef
23.
Wijffels MC, Dorland R, Mast F, et al. Widening of the excitable gap during pharmacological cardioversion of atrial fibrillation in the goat: effects of cibenzoline, hydroquinidine, flecainide, and d-sotalol. Circulation 2000; 102(2): 260–7PubMedCrossRef
24.
Kawase A, Ikeda T, Nakazawa K, et al. Widening of the excitable gap and enlargement of the core of reentry during atrial fibrillation with a pure sodium channel blocker in canine atria. Circulation 2003; 107(6): 905–10PubMedCrossRef
25.
Kneller J, Kalifa J, Zou R, et al. Mechanisms of atrial fibrillation termination by pure sodium channel blockade in an ionically-realistic mathematical model. Circ Res 2005; 96(5): e35–47PubMedCrossRef
26.
Chen YJ, Chen SA, Chang MS, et al. Arrhythmogenic activity of cardiac muscle in pulmonary veins of the dog: implication for the genesis of atrial fibrillation. Cardiovasc Res 2000; 48(2): 265–73PubMedCrossRef
27.
Chou CC, Zhou S, Miyauchi Y, et al. Effects of procaina-mide on electrical activity in thoracic veins and atria in canine model of sustained atrial fibrillation. AJP Heart Circulatory Physiol 2004; 286(5): H1936–45CrossRef
28.
Chen SA, Hsieh MH, Tai CT, et al. Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins: electrophysiological characteristics, pharmacological responses, and effects of radiofrequency ablation. Circulation 1999; 100(18): 1879–86PubMedCrossRef
29.
Suttorp MJ, Kingma JH, Lie AH, et al. Intravenous flecainide versus verapamil for acute conversion of paroxysmal atrial fibrillation or flutter to sinus rhythm. Am J Cardiol 1989; 63(11): 693–6PubMedCrossRef
30.
Capucci A, Boriani G, Botto GL, et al. Conversion of recent-onset atrial fibrillation by a single oral loading dose of propafenone or flecainide. Am J Cardiol 1994; 74(5): 503–5PubMedCrossRef
31.
Allessie M, Ausma J, Schotten U. Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovasc Res 2002; 54(2): 230–46PubMedCrossRef
32.
Nattel S, Singh BN. Evolution, mechanisms, and classification of antiarrhythmic drugs: focus on class III action. Am J Cardiol 1999; 84: 11R–9RPubMedCrossRef
33.
Li D, Melnyk P, Feng J, et al. Effects of experimental heart failure on atrial cellular and ionic electrophysiology. Circulation 2000; 101: 2631–8PubMedCrossRef
34.
Li D, Benardeau A, Nattel S. Contrasting efficacy of do-fetilide in differing experimental models of atrial fibrillation. Circulation 2000; 102: 104–12PubMedCrossRef
35.
Pedersen OD, Bagger H, Keller N, et al. Efficacy of dofe-tilide in the treatment of atrial fibrillation-flutter in patients with reduced left ventricular function: a Danish Investigation of Arrhythmia and Mortality ON Dofetilide (DIAMOND) substudy. Circulation 2001; 104: 292–6PubMedCrossRef
36.
Wang J, Bourne GW, Wang Z, et al. Comparative mechanisms of antiarrhythmic drug action in experimental atrial fibrillation: importance of use-dependent effects on refractoriness. Circulation 1993; 88: 1030–44PubMedCrossRef
37.
Roy D, Talajic M, Dorian P, et al. Amiodarone to prevent recurrence of atrial fibrillation. N Engl J Med 2000; 342: 913–20PubMedCrossRef
38.
Echt DS, Liebson PR, Mitchell LB, et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo: the cardiac arrhythmia suppression trial. N Engl J Med 1991; 324: 781–8PubMedCrossRef
39.
Coplen SE, Antman EM, Berlin JA, et al. Efficacy and safety of quinidine therapy for maintenance of sinus rhythm after cardioversion: a meta-analysis of randomized trials. Circulation 1990; 82: 1106–16PubMedCrossRef
40.
Waldo AL, Camm AJ, DeRuyter H, et al. Effect of d-sotalol on mortality in patients with left ventricular dysfunction after recent and remote myocardial infarction. Lancet 1996; 348: 7–12PubMedCrossRef
41.
Hohnloser SH, Singh BN. Proarrhythmia with class III antiarrhythmic drugs: definition, electrophysiologic mechanisms, incidence, predisposing factors, and clinical implications. J Cardiovasc Electrophysiol 1995; 6: 920–36PubMedCrossRef
42.
The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 2002; 347(23): 1825–33CrossRef
43.
Corley SD, Epstein AE, DiMarco JP, et al. Relationships between sinus rhythm, treatment, and survival in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study. Circulation 2004; 109(12): 1509–13PubMedCrossRef
44.
Ehrlich JR, Nattel S, Hohnloser SH. Novel anti-arrhythmic drugs for atrial fibrillation management. Curr Vasc Pharmacol 2007; 5(3): 185–95PubMedCrossRef
45.
Fedida D. Vernakalant (RSD1235): a novel, atrial-selective antifibrillatory agent. Expert Opin Investig Drugs 2007; 16(4): 519–32PubMedCrossRef
46.
Mao ZL, Wheeler JJ, Clohs L, et al. Pharmacokinetics of novel atrial-selective antiarrhythmic agent vernakalant hydrochloride injection (RSD 1235): influence of CYP2D6 expression and other factors. J Clin Pharmacol 2009; 49(1): 17–29PubMed
47.
Fedida D, Orth PM, Chen JY, et al. The mechanism of atrial antiarrhythmic action of RSD 1235. J Cardiovasc Electrophysiol 2005; 16(11): 1227–38PubMedCrossRef
48.
Comtois P, Sakabe M, Vigmond EJ, et al. Mechanisms of atrial fibrillation termination by rapidly unbinding Na+ channel blockers: insights from mathematical models and experimental correlates. Am J Physiol Heart Circ Physiol 2008; 295(4): H1489–504PubMedCrossRef
49.
Orth PM, Hesketh JC, Mak CK, et al. RSD1235 blocks late INa and suppresses early afterdepolarizations and torsades de pointes induced by class III agents. Cardiovasc Res 2006; 70(3): 486–96PubMedCrossRef
50.
Dorian P, Pinter A, Mangat I, et al. The effect of vernakalant (RSD1235), an investigational antiarrhythmic agent, on atrial electrophysiology in humans. J Cardiovasc Pharmacol 2007; 50(1): 35–40PubMedCrossRef
51.
Roy D, Rowe BH, Stiell IG, et al. A randomized, controlled trial of RSD1235, a novel anti-arrhythmic agent, in the treatment of recent onset atrial fibrillation. J Am Coll Cardiol 2004; 44(12): 2355–61PubMedCrossRef
52.
Roy D, Pratt CM, Torp-Pedersen C, et al. Vernakalant hydrochloride for rapid conversion of atrial fibrillation: a phase 3, randomized, placebo-controlled trial. Circulation 2008; 117(12): 1518–25PubMedCrossRef
53.
Kowey PR, Roy D, Pratt CM, et al. Efficacy and safety of vernakalant hydrochloride injection for the treatment of atrial fibrillation after valvular or coronary artery bypass surgery [abstract no. 2860]. Circulation 2007; 116(16): II–637
54.
Naccarelli GV, Wolbrette DL, Samii S, et al. Vernakalant: a promising therapy for conversion of recent-onset atrial fibrillation. Expert Opin Investig Drugs 2008; 17(5): 805–10PubMedCrossRef
55.
Noc M, Stajer D, Horvat M. Intravenous amiodarone versus verapamil for acute conversion of paroxysmal atrial fibrillation to sinus rhythm. Am J Cardiol 1990; 65(9): 679–80PubMedCrossRef
56.
Wegener FT, Ehrlich JR, Hohnloser SH. Dronedarone: an emerging agent with rhythm- and rate-controlling effects. J Cardiovasc Electrophysiol 2006; 17 Suppl. 2: S17–20PubMedCrossRef
57.
Touboul P, Brugada J, Capucci A, et al. Dronedarone for prevention of atrial fibrillation: a dose-ranging study. Eur Heart J 2003; 24(16): 1481–7PubMedCrossRef
58.
Damy T, Pousset F, Caplain H, et al. Pharmacokinetic and pharmacodynamic interactions between metoprolol and dronedarone in extensive and poor CYP2D6 metabolizers healthy subjects. Fundam Clin Pharmacol 2004; 18(1): 113–23PubMedCrossRef
59.
Gautier P, Guillemare E, Marion A, et al. Electrophysiologic characterization of dronedarone in guinea pig ventricular cells. J Cardiovasc Pharmacol 2003; 41(2): 191–202PubMedCrossRef
60.
Celestino D, Medei E, Moro S, et al. Acute in vitro effects of dronedarone, an iodine-free derivative, and amiodarone, on the rabbit sinoatrial node automaticity: a comparative study. J Cardiovasc Pharmacol Ther 2007; 12(3): 248–57PubMedCrossRef
61.
Altomare C, Barbuti A, Viscomi C, et al. Effects of dronedarone on acetylcholine-activated current in rabbit SAN cells. Br J Pharmacol 2000; 130(6): 1315–20PubMedCrossRef
62.
Guillemare E, Marion A, Nisato D, et al. Inhibitory effects of dronedarone on muscarinic K+ current in guinea pig atrial cells. J Cardiovasc Pharmacol 2000; 36(6): 802–5PubMedCrossRef
63.
Thomas D, Kathofer S, Zhang W, et al. Acute effects of dronedarone on both components of the cardiac delayed rectifier K+ current, HERG and KvLQT1/minK potassium channels. Br J Pharmacol 2003; 140(5): 996–1002PubMedCrossRef
64.
Varro A, Takacs J, Nemeth M, et al. Electrophysiological effects of dronedarone (SR 33589), a noniodinated amiodarone derivative in the canine heart: comparison with amiodarone. Br J Pharmacol 2001; 133(5): 625–34PubMedCrossRef
65.
Lalevee N, Nargeot J, Barrere-Lemaire S, et al. Effects of amiodarone and dronedarone on voltage-dependent sodium current in human cardiomyocytes. J Cardiovasc Electrophysiol 2003; 14(8): 885–90PubMedCrossRef
66.
Watanabe Y, Kimura J. Acute inhibitory effect of dronedarone, a noniodinated benzofuran analogue of amiodarone, on Na(+)/Ca(2+) exchange current in guinea pig cardiac ventricular myocytes. Naunyn Schmiedebergs Arch Pharmacol 2008; 377(46): 371–6PubMedCrossRef
67.
Sun W, Sarma JS, Singh BN. Chronic and acute effects of dronedarone on the action potential of rabbit atrial muscle preparations: comparison with amiodarone. J Cardiovasc Pharmacol 2002; 39(5): 677–84PubMedCrossRef
68.
Moro S, Ferreiro M, Celestino D, et al. In vitro effects of acute amiodarone and dronedarone on epicardial, endocardial, and M cells of the canine ventricle. J Cardiovasc Pharmacol Ther 2007; 12(4): 314–21PubMedCrossRef
69.
Verduyn SC, Vos MA, Leunissen HD, et al. Evaluation of the acute electrophysiologic effects of intravenous drone-darone, an amiodarone-like agent, with special emphasis on ventricular repolarization and acquired torsade de pointes arrhythmias. J Cardiovasc Pharmacol 1999; 33(2): 212–22PubMedCrossRef
70.
Kodama I, Kamiya K, Toyama J. Cellular electropharmacology of amiodarone. Cardiovasc Res 1997; 35(1): 13–29PubMedCrossRef
71.
Sun W, Sarma JS, Singh BN. Electrophysiological effects of dronedarone (SR33589), a noniodinated benzofuran derivative, in the rabbit heart: comparison with amiodarone. Circulation 1999; 100: 2276–81PubMedCrossRef
72.
Stoykov I, van Beeren HC, Moorman AF, et al. Effect of amiodarone and dronedarone administration in rats on thyroid hormone-dependent gene expression in different cardiac components. Eur J Endocrinol 2007; 156(6): 695–702PubMedCrossRef
73.
Shinagawa K, Shiroshita-Takeshita A, Schram G, et al. Effects of antiarrhythmic drugs on fibrillation in the remodeled atrium: insights into the mechanism of amio-darone’s superior efficacy. Circulation 2003; 107(10): 1440–6PubMedCrossRef
74.
Singh BN, Connolly SJ, Crijns HJ, et al. Dronedarone for maintenance of sinus rhythm in atrial fibrillation or flutter. N Engl J Med 2007; 357(10): 987–99PubMedCrossRef
75.
Kober L, Torp-Pedersen C, McMurray JJ, et al. Increased mortality after dronedarone therapy for severe heart failure. N Engl J Med 2008; 358(25): 2678–87PubMedCrossRef
76.
Davy JM, Herold M, Hoglund C, et al. Dronedarone for the control of ventricular rate in permanent atrial fibrillation: the Efficacy and safety of dRonedArone for the cOntrol of ventricular rate during atrial fibrillation (ERATO) study. Am Heart J 2008; 156(3): 527–9PubMedCrossRef
77.
Hohnloser SH, Crijns HJ, van Eickels M, et al. Effect of dronedarone on cardiovascular events in atrial fibrillation. N Engl J Med 2009; 360(7): 668–78PubMedCrossRef
78.
79.
Tschuppert Y, Buclin T, Rothuizen LE, et al. Effect of dronedarone on renal function in healthy subjects. Br J Clin Pharmacol 2007; 64(6): 785–91PubMed
80.
Guerra PG, Talajic M, Roy D, et al. Is there a future for antiarrhythmic drug therapy? Drugs 1998; 56(5): 767–81PubMedCrossRef
81.
Burstein B, Nattel S. Atrial fibrosis: mechanisms and clinical relevance in atrial fibrillation. J Am Coll Cardiol 2008; 51(8): 802–9PubMedCrossRef
82.
Pedersen OD, Bagger H, Kober L, et al. Trandopril reduces the incidence of atrial fibrillation after acute myocardial infarction in patients with left ventricular dysfunction. Circulation 1999; 100: 376–80PubMedCrossRef
83.
Vermes E, Tardif JC, Bourassa MG, et al. Enalapril decreases the incidence of atrial fibrillation in patients with left ventricular dysfunction: insight from the Studies of Left Ventricular Dysfunction (SOLVD) trials. Circulation 2003; 107(23): 2926–31PubMedCrossRef
84.
Wachtell K, Lehto M, Gerdts E, et al. Angiotensin II receptor blockade reduces new-onset atrial fibrillation and subsequent stroke compared to atenolol: the Losartan Intervention For End Point Reduction in Hypertension (LIFE) study. J Am Coll Cardiol 2005; 45(5): 712–9PubMedCrossRef
85.
Belluzzi F, Sernesi L, Preti P, et al. Prevention of recurrent lone atrial fibrillation by the angiotensin-II converting enzyme inhibitor ramipril in normotensive patients. J Am Coll Cardiol 2009; 53: 24–9PubMedCrossRef
86.
Murray KT, Rottman JN, Arbogast PG, et al. Inhibition of angiotensin II signaling and recurrence of atrial fibrillation in AFFIRM. Heart Rhythm 2004; 1(6): 669–75PubMedCrossRef
87.
Madrid AH, Bueno MG, Rebollo JM, et al. Use of irbesartan to maintain sinus rhythm in patients with long-lasting persistent atrial fibrillation: a prospective and randomized study. Circulation 2002; 106(3): 331–6PubMedCrossRef
88.
Ueng KC, Tsai TP, Yu WC, et al. Use of enalapril to facilitate sinus rhythm maintenance after external cardioversion of long-standing persistent atrial fibrillation: results of a prospective and controlled study. Eur Heart J 2003; 24(23): 2090–8PubMedCrossRef
89.
Connolly S, Pogue J, Hart R, et al. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbe-sartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial. Lancet 2006; 367(9526): 1903–12PubMedCrossRef
90.
Goette A, Breithardt G, Fetsch T, et al. Angiotensin II antagonist in Paroxysmal Atrial Fibrillation (ANTIPAF) trial: rationale and study design. Clin Drug Investig 2007; 27(10): 697–705PubMedCrossRef
91.
Disertori M, Latini R, Maggioni AP, et al. Rationale and design of the GISSI-Atrial Fibrillation Trial: a randomized, prospective, multicentre study on the use of valsartan, an angiotensin II AT1-receptor blocker, in the prevention of atrial fibrillation recurrence. J Cardiovasc Med (Hagerstown) 2006; 7(1): 29–38CrossRef
92.
Shiroshita-Takeshita A, Brundel BJ, Burstein B, et al. Effects of simvastatin on the development of the atrial fibrillation substrate in dogs with congestive heart failure. Cardiovasc Res 2007; 74(1): 75–84PubMedCrossRef
93.
Bachmann JM, Majmudar M, Tompkins C, et al. Lipid-altering therapy and atrial fibrillation. Cardiol Rev 2008; 16(4): 197–204PubMedCrossRef
94.
Shiroshita-Takeshita A, Brundel BJ, Lavoie J, et al. Pred-nisone prevents atrial fibrillation promotion by atrial tachycardia remodeling in dogs. Cardiovasc Res 2006; 69(4): 865–75PubMedCrossRef
95.
Ishii Y, Schuessler RB, Gaynor SL, et al. Inflammation of atrium after cardiac surgery is associated with in-homogeneity of atrial conduction and atrial fibrillation. Circulation 2005; 111(22): 2881–8PubMedCrossRef
96.
Dernellis J, Panaretou M. Relationship between C-reactive protein concentrations during glucocorticoid therapy and recurrent atrial fibrillation. Eur Heart J 2004; 25(13): 1100–7PubMedCrossRef
97.
Prasongsukarn K, Abel JG, Jamieson WR, et al. The effects of steroids on the occurrence of postoperative atrial fibrillation after coronary artery bypass grafting surgery: a prospective randomized trial. J Thorac Cardiovasc Surg 2005; 130(1): 93–8PubMedCrossRef
98.
Dorian P, Singh BN. Upstream therapies to prevent atrial fibrillation. Eur Heart J 2008; 10 Suppl. H: H11–31CrossRef
99.
Fuster V, Ryden LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 2006; 114(7): e257–354PubMedCrossRef
100.
Noheria A, Kumar A, Wylie Jr JV, et al. Catheter ablation vs antiarrhythmic drug therapy for atrial fibrillation: a systematic review. Arch Intern Med 2008; 168(6): 581–6PubMedCrossRef
101.
Wazni OM, Marrouche NF, Martin DO, et al. Radio-frequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial. JAMA 2005; 293(21): 2634–40PubMedCrossRef
102.
Pappone C, Augello G, Sala S, et al. A randomized trial of circumferential pulmonary vein ablation versus antiarrhythmic drug therapy in paroxysmal atrial fibrillation: the APAF Study. J Am Coll Cardiol 2006; 48(11): 2340–7PubMedCrossRef
103.
Stabile G, Bertaglia E, Senatore G, et al. Catheter ablation treatment in patients with drug-refractory atrial fibrillation: a prospective, multi-centre, randomized, controlled study (Catheter Ablation For The Cure Of Atrial Fibrillation Study). Eur Heart J 2006; 27(2): 216–21PubMedCrossRef
104.
Naccarelli GV, Gonzalez MD. Atrial fibrillation and the expanding role of catheter ablation: do antiarrhythmic drugs have a future? J Cardiovasc Pharmacol 2008; 52(3): 203–9PubMedCrossRef
Metadata
Title
Novel Approaches for Pharmacological Management of Atrial Fibrillation
Authors
Dr. Joachim R. Ehrlich
Stanley Nattel
Publication date
01-05-2009
Publisher
Springer International Publishing
Published in
Drugs / Issue 7/2009
Print ISSN: 0012-6667
Electronic ISSN: 1179-1950
DOI
https://doi.org/10.2165/00003495-200969070-00001

Other articles of this Issue 7/2009

Drugs 7/2009 Go to the issue

Adis Drug Evaluation

Exemestane

Adis Drug Profile

Emtricitabine/Tenofovir Disoproxil Fumarate

Adis Drug Evaluation

Sugammadex

Adis Drug Profile

Aliskiren/Hydrochlorothiazide Combination

Adis Drug Evaluation

Bortezomib

Review Article

Ceftaroline