Page 267 - Basic _ Clinical Pharmacology ( PDFDrive )

CHAPTER 14 Agents Used in Cardiac Arrhythmias 253

C ASE STUD Y ANSWER

The patient has significant symptoms during recurrent epi- particularly high. Maintenance of sinus rhythm appears to
sodes of atrial fibrillation. She has multiple risk factors for be important in this patient. The echocardiogram demon-
thromboembolism (age, female gender, and hypertension). strates impairment of left ventricular function. Selection of
Therefore, she is a candidate for lifelong anticoagulation. a drug that is tolerated in heart failure and has documented
Warfarin was the standard drug. The factor Xa (eg, apixa- ability to convert or prevent atrial fibrillation, eg, dofetilide
ban, rivaroxiban) and the direct thrombin (eg, dabigatran) or amiodarone, would be appropriate. The use of catheter
inhibitors are newer classes of anticoagulants that offer ablation for treatment of the initial episode of atrial fibril-
more patient-acceptable alternatives but at a higher cost. lation is not the standard of care but is undergoing clinical
The peak heart rate in this patient’s atrial fibrillation is not trials.