Observations On the Contrary

From rags to riches: the atrial fibrillation story

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e3871 (Published 07 June 2012) Cite this as: BMJ 2012;344:e3871
  1. Tony Delamothe, deputy editor, BMJ
  1. tdelamothe{at}bmj.com

Irregularly irregular

Suddenly, irregular heart beat in general and atrial fibrillation in particular is everywhere. The past fortnight alone has seen “heart rhythm week,” organised by the Arrythmia Alliance (patron: Tony Blair), and the National Institute for Health and Clinical Excellence recommend rivaroxaban as stroke prophylaxis for some patients with atrial fibrillation. Although we can’t be sure which cardiac rhythm the footballer Fabrice Muamba collapsed with in March, his “death” and “resurrection” have turned the beatifically smiling footballer into the patron saint of arrhythmias, with his doctors not far behind.

But to return to atrial fibrillation and its humble back story. Not so long ago the main treatment option for the condition was digoxin, one of the active ingredients of a traditional folk remedy for dropsy. Introduced in the 1930s, the drug costs the NHS about £0.04 (€0.05; $0.06) a patient for a daily dose. Costing much the same is warfarin, used to reduce the risk of embolic stroke.

In the past few years, however, new drugs have been crowding in for consideration: dronedarone (for persistent or paroxysmal atrial fibrillation) and angiotensin receptor blockers (for preventing new onset atrial fibrillation). The device industry …

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