Atrial-selective pharmacological therapy for atrial fibrillation: hype or hope?
Bibliographic record
Abstract
PURPOSE OF REVIEW: Rhythm control remains of therapeutic value for many atrial fibrillation patients despite no evidence of survival benefit. This lack of benefit may relate to side effects of conventional antiarrhythmic drugs. The introduction of novel agents was a logical consequence. RECENT FINDINGS: Novel antiarrhythmics are currently being evaluated in preclinical or clinical studies. Among recently developed drugs, some affect one or more atrial targets, including I Kur, I KACh, INa or I SAC, allowing them to act selectively on atria over ventricles. Some drugs that exhibit atrial selectivity have not been successful in preliminary studies. Block of a single atrial-specific target may be insufficient for atrial fibrillation termination and prevention, and multichannel-blocking properties may be a useful alternate approach. Drugs such as vernakalant or ranolazine inhibit multiple channels but display effective and atrial-selective actions. Furthermore, dronedarone, a prototypic multichannel blocker with additional effects on ventricular myocardium, has proven well tolerated and effective in the treatment of atrial fibrillation and may even reduce cardiovascular mortality. SUMMARY: Efforts to develop atrial-selective antiarrhythmics are bearing fruit, but such compounds will need to exhibit equal or superior safety and efficacy compared with multichannel blockers such as dronedarone for atrial fibrillation suppression in order to prove their worth. It is still too early to tell whether atrial selectiveness is just hype or truly a hope for antiarrhythmic drug treatment of atrial fibrillation.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.004 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".