Canadian Cardiovascular Society XXXX guidelines 2010: rate and rhythm management.

@entity1 @entity2643 @entity299 @entity6237 @entity956 @entity24724 @entity460 @entity955 @entity2778 @entity583 @entity943 @entity2779 @entity1002
The goals of @entity955 ( @entity955 ) and @entity956 ( @entity956 ) @entity943 management are to alleviate @entity1 symptoms, improve @entity1 quality of life, and minimize the morbidity associated with @entity955 and @entity956 . @entity943 management usually commences with drugs to slow the ventricular rate. The addition of class I or class III antiarrhythmic drugs for restoration or maintenance of sinus rhythm is largely determined by @entity1 symptoms and preferences. For rate control, treatment of persistent or permanent @entity955 and @entity956 should aim for a resting heart rate of <100 beats per minute. Beta-blockers or nondihydropyridine @entity460 channel blockers are the initial therapy for rate control of @entity955 and @entity956 in most @entity1 without a history of @entity583 or @entity1002 . Digoxin is not recommended as monotherapy for rate control in active @entity1 . Digoxin and @entity24724 may be used in combination with other agents to optimize rate control. The first-choice antiarrhythmic drug for maintenance of sinus rhythm in @entity1 with non structural @entity299 can be any one of @entity24724 , @entity6237 , @entity2779 , or @entity2778 . In @entity1 with abnormal ventricular function but left ventricular ejection fraction >35%, @entity24724 , @entity2778 , or @entity2643 is recommended. In @entity1 with left ventricular ejection fraction <35%, @entity2643 is the only drug usually recommended. Intermittent antiarrhythmic drug therapy ("pill in the pocket") may be considered in symptomatic @entity1 with infrequent, longer-lasting episodes of @entity955 or @entity956 as an alternative to daily antiarrhythmic therapy. Referral for ablation of @entity955 may be considered for @entity1 who remain symptomatic after adequate trials of antiarrhythmic drug therapy and in whom a rhythm control strategy remains desired.
