Atrial Arrhythmias

Better antiarrhythmic drugs are needed for the acute termination of atrial tachycardia and fibrillation, whether of recent onset or long term. This remains a goal even if it is accepted that control of ventricular rate in atrial fibrillation is as good a therapeutic goal as reversion to sinus rhythm. However, to some extent the processes responsible for these arrhythmias are irreversible and the arrhythmia will eventually return. Additionally, reversion to sinus rhythm of longstanding atrial fibrillation carries the risk of emboli being dislodged from the atria, as a result of the sudden vigorous and coordinated contraction of atria upon resumption of sinus rhythm.

Despite the availability of electrical conversion for atrial arrhythmias, there is a need for:

1. Quick and simple conversion of supraventricular arrhythmias with drugs given intravenously or orally, together with a need for better prophylaxis against the recurrence of supraventricular arrhythmias.

2. Better antiarrhythmic drugs for the control of ventricular rate during atrial fibrillation. The current drugs (b-adrenoceptor blockers, calcium channel blockers, cardiac glycosides) are far from ideal. For instance, a cardiac selective L-type calcium channel blocker might have advantages in that it would be less likely to lower blood pressure.

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