Treatment of Acute Atrial Fibrillation: Ventricular Rate Control and Restoration of Sinus Rhythm

Atrial fibrillation (AF) is a familiar arrhythmia seen in the emergency department and the general population. In the past it was treated in the majority of cases by controlling the ventricular rate, whether the AF is acute or chronic. However, ventricular rate control alone does not address the underlying problem and the patients still remain in AF, cardiac output and symptoms have not been optimally corrected. There is definite risk of thromboembolism. Restoration of sinus rhythm is the only way of resuming the normal conduction physiology of the heart and correcting these problems This article provides a review of the two major principles of rhythm treatment of acute AF: rate control and restoration of sinus rhythm. Transthoracic electrical cardioversion is the mainstay of treatment in haemodynamically unstable AF, whereas in stable AF, there is a choice between rate control and restoration of sinus rhythm, or they can be carried out in conjunction with each other.

Advice for Young Travelers

Children who live or travel in developing countries are at a small but definite risk of acquiring certain diseases that they would be unlikely to encounter had they remained in North America. Pediatricians who counsel such children and their famailies need to give competent and current advice about immunizations, chemoprophylaxis, and other maneuvers designed to maintain health. This review has outlined a general disease prevention program appropriate for children who travel to developing countires.

Comparative Politics: A Comprehensive Approach

This is a tentative outline of a systematic and comprehensive approach to the study of politics. Part I gives the method. Part II indicates some advantages of the approach. Part III anticipates likely objections to it. And Part IV suggests some applications. My purpose in presenting the paper in its present form is to encourage my colleagues to consider this approach and, if they find it potentially useful, to contribute to its refinement through criticism. As David Easton said in his “Approach to the Analysis of Political Systems,” I know “I run the definite risk that the meaning and implications of this point of view may be only superficially communicated; but it is a risk I shall have to undertake since I do not know how to avoid it sensibly.”