Clinical Overview of Atrial Fibrillation

1
Clinical Overview of Atrial Fibrillation

• Edward L.C. Pritchett, M.D.
• Consulting Professor of MedicineDivisions of
  Cardiology and Clinical Pharmacology
• Duke University Medical CenterDurham, North
  Carolina

2
Atrial Fibrillation Prevalence

• Most common sustained cardiac arrhythmia1
• Most common diagnosis for arrhythmia-related
  hospitalization2
• Estimated gt2.3 million US adults have AF3
• Prevalence of AF increases with age and with an
  aging population4

1 Bialy D et al. J Am Coll Cardiol 1992
19-41A. 2 Fuster V et al. Circulation 2006
114e257-e354 3 Go AS et al. JAMA 2001
2852370-2375. 4 Chug SS et al. J Am Coll Cardiol
2001 37371-378
3
Clinical Presentation of Atrial Fibrillation

• Atrial fibrillation is most commonly identified
  because patients have symptoms1
• The most appropriate use of antiarrhythmic drugs
  in patients with atrial fibrillation is for
  relief of symptoms2,3
• Symptoms closely associated with occurrence of
  atrial fibrillation are palpitations, dyspnea,
  chest pain, dizziness, asthenia, fatigue,
  nervousness, increased sweating4

1 Psaty BM et al. Circulation 1997962455-2461. 2
Page RL. N Eng J Med 20043512408-2416 3 Fuster
V et al. Circulation 2006114e257-e354. 4
Bhandari AK et al. Am Heart J 1992124381-386.
4
Symptomatic Arrhythmias as an Outcome in
Antiarrhythmic Drug Approvals for Atrial
Fibrillation and Other Supraventricular
Arrhythmias

• 1986 verapamil PO IR - PSVT
• 1991 flecainide PO - PSVT, AF
• 1996 ibutilide IV - AF
• 1997 propafenone PO IR - PSVT, AF
• 1999 dofetilide PO - AF
• 2000 d,l sotalol PO - AF
• 2003 propafenone SR PO - AF

Pritchett E, PACE, 1998211457-1469.
5
Limitations of Current Therapies

• Pharmacological Conversion with
• IV Antiarrhythmic Drugs
• Few choices of approved and labeled drugs
• Imperfect efficacy
• Adverse effects (ventricular arrhythmias)
• Electrical Cardioversion
• Requires conscious sedation
• Complications (skin burns, aspiration,
  bradycardia, ventricular arrhythmia)
• Inappropriate in some clinical situations
  (post-prandial, lung disease, recent cardiac
  surgery)

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Desirable Characteristics of Pharmacologic
Converting Agents

• Efficacy
• High rate of restoring sinus rhythm with relief
  of symptoms
• Rapid onset of action
• Safety
• Low rate of adverse effects
• Low incidence of drug interactions
• Lack of interference with electrical cardioversion