Upstream Therapy (Pathogenetic Atrial Fibrillation Therapy)

Upstream Therapy (Pathogenetic Atrial Fibrillation Therapy)

It is known that taking angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, statins, omega-3 fatty acids and eating fatty fish reduce the incidence of AF. Recently, it has been shown that the administration of colchicine in the postoperative period significantly reduces the incidence of AF after cardiac surgery.

The “tablet in your pocket” approach. To avoid daily medication, some patients with infrequent episodes of paroxysmal atrial fibrillation (AF) may use the “pill in pocket” approach. According to this method, when a heartbeat occurs, the patient should take flekainid (200 mg) or propafenone (600 mg). If successful within 2-3 hours, we can expect a recovery of sinus rhythm. This strategy is rational for patients with rare but long-term episodes of AF, since it avoids the need for hospitalization.

However, in some patients with paroxysmal atrial fibrillation (AF), experiencing serious symptoms that violate the capacity, the use of the “pill in pocket” approach in the event of arrhythmia cannot be considered adequate. In addition, patients with coronary artery disease or with reduced ventricular contractility should not use these drugs, and since, due to their action, there is a high likelihood of atrial flutter or atrial tachycardia with a very high frequency of ventricular contractions, it is preferable to combine these drugs with drugs that block AV conduction (i.e. with BAB or calcium channel blockers).

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