Drugs, Biologicals, and Ablation

Atrial fibrillation (AF) is characterized by rapid, seemingly chaotic atrial activation, characterized by the lack of an organized P wave and irregularly irregular ventricular activation (QRSs) on surface ECG. AF manifests as a result of multiple heterogeneous groups of disorders. For example, AF can occur idiopathically (so-called lone AF), be related to familial inheritance with specific genetic mutations, or, most commonly, associated with hypertension or underlying structural heart diseases, such as valvular heart disease or cardiomyopathy. Current therapy for AF is targeted at treating symptoms and reducing risk of tachycardia-induced cardiomyopathy and stroke. Stroke has been addressed elsewhere recently. In many patients, symptoms of AF can be treated with rate control, typically achieved by atrioventricular nodal blocking drugs, such as β-blockers or L-type calcium channel blockers. In patients in whom rate control is insufficient, antiarrhythmic drugs (AADs) and ablation are used to attempt to maintain sinus rhythm (rhythm control). This review will focus on strategies aimed at rhythm control. Compendium