Treatment of atrial fibrillation and atrial flutter

Torsten Christ, Simon Pecha, N. Jost

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Atrial fibrillation (AF) is the most common arrhythmia in humans. Therapeutic goals are normalization of ventricular rate (rate control) or restoration of sinus rhythm (SR, rhythm control). Drugs can achieve both aims. Early therapeutic approaches included the use of plant glycosides, digitalis (from Digitalis lanata, Digitalis purpure a) for rate control and alkaloid, quinidine, for rhythm control. For the latter indication, sodium channel blockers became popular in the middle of the last century. However, awareness of disastrous ventricular proarrhythmia caused by sodium channel blockers in heart failure patients has reduced their use in AF. Amiodarone “ a mixed channel blocker ” is not associated with ventricular proarrhythmia, but its severe extracardiac toxicity limits its use in AF. Nevertheless, this compound has gained some popularity in treating atrial fibrillation and atrial flutter. Over the last two decades, intensive basic science research in the field of human atrial electrophysiology identified ion channels expressed selectively in the atrium but not in the ventricle (e.g., IKurIK, ACh SK channels). Those channels have gained enormous attention since they could represent targets for atrial antiarrhythmic drug therapy without the risk for ventricular arrhythmia. However atrial-selective expression of a given ion channel is not sufficient to qualify it as a drug target. Blockade of atrial-selective ion channels should affect atrial electrophysiology to an extent sufficiently large to stop or to prevent AF. Blockers of IKur and IK, Ach have entered first trials in humans. Sarcoplasmic reticulum may represent another target. Enhanced spontaneous Ca 2+-release from the sarcoplasmic reticulum may drive enhanced cardiac automaticity, which is believed to initiate and/or to maintain AF. Usefulness of such interventions remains to be proven. Therefore, this chapter reviews classic antiarrhythmic drugs used in atrial fibrillation/flutter and some new compounds recently approved or under development.

Original languageEnglish
Title of host publicationPathophysiology and Pharmacotherapy of Cardiovascular Disease
PublisherSpringer International Publishing
Pages1059-1079
Number of pages21
ISBN (Print)9783319159614, 9783319159607
DOIs
Publication statusPublished - Jan 1 2015

Fingerprint

Atrial Flutter
Atrial Fibrillation
Ion Channels
Sodium Channel Blockers
Digitalis
Electrophysiology
Anti-Arrhythmia Agents
Sarcoplasmic Reticulum
Therapeutics
Cardiac Arrhythmias
Digitalis Glycosides
Quinidine
Amiodarone
Alkaloids
Pharmaceutical Preparations
Heart Failure
Drug Therapy
Research

Keywords

  • Atrial fibrillation
  • Atrial flutter
  • Atrial selective
  • Ion channel block
  • Proarrhythmic effects
  • Selectivity

ASJC Scopus subject areas

  • Medicine(all)
  • Pharmacology, Toxicology and Pharmaceutics(all)

Cite this

Christ, T., Pecha, S., & Jost, N. (2015). Treatment of atrial fibrillation and atrial flutter. In Pathophysiology and Pharmacotherapy of Cardiovascular Disease (pp. 1059-1079). Springer International Publishing. https://doi.org/10.1007/978-3-319-15961-4_50

Treatment of atrial fibrillation and atrial flutter. / Christ, Torsten; Pecha, Simon; Jost, N.

Pathophysiology and Pharmacotherapy of Cardiovascular Disease. Springer International Publishing, 2015. p. 1059-1079.

Research output: Chapter in Book/Report/Conference proceedingChapter

Christ, T, Pecha, S & Jost, N 2015, Treatment of atrial fibrillation and atrial flutter. in Pathophysiology and Pharmacotherapy of Cardiovascular Disease. Springer International Publishing, pp. 1059-1079. https://doi.org/10.1007/978-3-319-15961-4_50
Christ T, Pecha S, Jost N. Treatment of atrial fibrillation and atrial flutter. In Pathophysiology and Pharmacotherapy of Cardiovascular Disease. Springer International Publishing. 2015. p. 1059-1079 https://doi.org/10.1007/978-3-319-15961-4_50
Christ, Torsten ; Pecha, Simon ; Jost, N. / Treatment of atrial fibrillation and atrial flutter. Pathophysiology and Pharmacotherapy of Cardiovascular Disease. Springer International Publishing, 2015. pp. 1059-1079
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