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    More than one-third of patients with AF are aged 80 or older.2 The atrioventricular (AV) node serves as a gatekeeper in the atrium, delaying electrical pulses before they move on to the ventricles, causing contraction.1 In AF, the AV node is unable to adequately manage all of these electrical pulses, and the loss of coordinated atrial contractions results in a sequela of clinical implications including increased ventricular rate; decreased diastolic filling; and reduced cardiac output, blood stasis, and blood clot formation.1,3 As a result, impaired cardiac function and increased stroke risk lead to significant morbidity and mortality.1-3 Additionally, the cost of caring for patients with AF is estimated to be five times greater than caring for patients without the condition.3 Symptomology for individual patients with AF ranges from no symptoms to fatigue, palpitations, dyspnea, hypotension, syncope, lightheadedness, chest pain, or heart failure, stroke or cardiovascular collapse. About 1% of patients with AF are under the age of 60, whereas up to 12% of patients are between the ages of 75 and 84. 6 Atrial fibrillation (AF) is the most common type of arrhythmia and the leading cause of cardioembolic stroke, with AF patients being five times more likely to experience a stroke than those without AF.1 The median age for patients with AF is approximately 75, with an increase in incidence occurring with advancing age. Because of the nonspecific nature of symptoms, an electrocardiogram (ECG) is often required to evaluate for the onset and diagnoses of AF.1-3 ECG results can vary depending on the type of AF; however, common interpretation shows irregular R-R intervals (when AV conduction is present), the absence of distinct repeating P waves, and irregular atrial activity.2 If electrocardiography fails to demonstrate AF, the use of a Holter or cardiac event monitor may be required to document the arrhythmia.1-3 Rate Control vs Rhythm Control Decreasing the ventricular response rate, known as rate control, improves diastolic filling and coronary perfusion, decreases myocardial energy demand, and prevents tachycardia-mediated cardiomyopathy.3 Most experts recommend aiming for a ventricular response of less than 80 beats per minute at rest and less than 110 beats per minute during exercise.3,4 One randomized controlled trial showed that lenient rate control, defined as a ventricular rate of less than 110 beats per minute at rest, was not inferior to strict rate control in preventing cardiac death, heart failure, stroke, and life-threatening arrhythmias.3,5 At this time, it may be best to reserve this less aggressive approach for patients with no symptoms or acceptable symptoms and left ventricular (LV) ejection fraction 40%.6 The use of rate control medications (eg, calcium channel blockers, beta blockers) avoids subjecting patients to riskier rhythm control medications (eg, antiarrhythmics). The Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) trial showed that a rhythm control strategy was not better than a rate control strategy for improving survival in patients with AF. Data show that patients assigned to rhythm control medications experience more hospitalizations from adverse cardiovascular events, more serious adverse medication effects, and the same rate of thromboembolic events compared with patients using rate control medications.3 Because of lower cost, improved tolerability, and ease of use, most prescribers will first utilize a rate control strategy before progressing to rhythm control. Studies indicate that unless rate control has not worked, it is less important to aggressively drive patients into a normal sinus rhythm. Metoprolol Succinate Oral Uses, Side Effects, Interactions. buy viagra spain Metoprolol for preventing relapse in AF? - Medscape Drugs for Conversion of Atrial Fibrillation - American Family Physician
     
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