III. CAUSES AND RESEARCH IMPLICATIONS
Diseases or disorders that cause atrial fibrillation are shown in Fig. 2. Due to the vast number of both serious diseases and disorders that cause atrial fibrillation, it is not sur¬prising that a definitive cure is rarely possible. This has become most frustrating for cardiologists and technologists who strive to provide advances in technologic equipment and strategies for the management of atrial fibrillation.The prevention of atrial fibrillation is therefore of para¬mount importance. There has been little focus in the past 20 years on the prevention of this abnormality.
A. Hypertension
Because the cure and management of atrial fibrillation is most often difficult, it is necessary to prevent the occurrence of atrial fibrillation by aggressive management of conditions that cause atrial fibrillation. The aggressive management of hypertension is very important. Unfortu¬nately, despite more than 50 years of extensive research by national bodies and pharmaceutical firms and the major advertisement of new drugs available for the management of hypertension, only four antihypertensive agents are available.
These agents include diuretics, beta-blockers, calcium blockers, and ACE inhibitors. The recently added new agents, angiotensin receptor blockers, are really no different from ACE inhibitors but appear to have a lesser incidence of adverse effects. There are more than 12 diuretics, 15 beta-blockers, 10 calcium antagonists, 14 ACE inhibitors, and 6 angiotensin receptor blockers available, but these represent only 4 active agents. In addition diuretics, beta-blockers, or ACE inhibitors achieve the goal blood pressure of less than 140 mmHg in less than 50% of patients. Often two drugs must be used for control, thus reducing patient compliance. Calcium antagonists are effective in approximately 65% of patients, but they are not cardioprotective and carry increased risk for the causation of heart failure in the elderly and in patients with heart disease.