saeid bourbour | Islamic Azad University, South Tehran Branch (original) (raw)
Papers by saeid bourbour
Atrial fibrillation is a supraventricular tachyarrhythmia with significant consequences in terms ... more Atrial fibrillation is a supraventricular tachyarrhythmia with significant consequences in terms of morbidity and mortality. In light of the limitations of available pharmacologic treatment options (suboptimal efficacy plus safety and tolerability issues), atrial fibrillation management should be individualized based on patient characteristics and comorbidities that could influence response to specific management approaches. The importance of adequate anticoagulation should not be overlooked. This review provides a practical guide for primary care physicians, internists, and cardiologists on current management strategies for atrial fibrillation, based on recent guidelines and current clinical data. Atrial fibrillation is the most common cardiac rhythm disturbance encountered by physicians in clinical practice. 1 Atrial fibrillation is characterized by uncoordinated atrial activation, and if not managed appropriately, may be associated with significant morbidity and mortality and a reduction in quality of life. 2 It is estimated that 2.3 million Americans and 4.5 million Europeans are affected by atrial fibrillation, which predominantly impacts persons Ͼ65 years of age. 2 By the year 2050 it is estimated that more than 5.5 million people in the United States will have atrial fibrillation. 1 Atrial fibrillation presents in specific patterns and can be classified as paroxysmal (self-terminating and lasting Ͻ7 days), persistent (not self-terminating and lasting Ͼ7 days), and permanent (lasting Ͼ1 year and/or refractory to cardio-version). 3 Paroxysmal atrial fibrillation and persistent atrial fibrillation are not mutually exclusive, and individuals may experience both at different times. A patient's atrial fibril-lation often is characterized based on the most frequent or most sustained presentation. Well-known risk factors for atrial fibrillation include coronary artery disease (CAD), diabetes, heart failure, hypertension, hyperthyroidism, and myocardial infarction. 4 In animal models, atrial fibrillation has been shown to cause electrophysiologic changes in the atrium, including marked shortening of the atrial effective refractory period. 5,6 With continued atrial fibrillation, contractile and structural remodeling occurs, and atrial fibrillation can become self-sustained, no longer requiring a trigger. 5,7,8 Electrical , contractile, and structural changes also have been observed in humans, and it has been noted that the duration of atrial fibrillation tends to correlate well with the progression of these changes. 9-12 In addition to shortening of the atrial effective refractory period, several other factors have been associated with structural remodeling in atrial fibrilla-tion. These include aging, alcohol consumption, autonomic
Atrial fibrillation is a supraventricular tachyarrhythmia with significant consequences in terms ... more Atrial fibrillation is a supraventricular tachyarrhythmia with significant consequences in terms of morbidity and mortality. In light of the limitations of available pharmacologic treatment options (suboptimal efficacy plus safety and tolerability issues), atrial fibrillation management should be individualized based on patient characteristics and comorbidities that could influence response to specific management approaches. The importance of adequate anticoagulation should not be overlooked. This review provides a practical guide for primary care physicians, internists, and cardiologists on current management strategies for atrial fibrillation, based on recent guidelines and current clinical data. Atrial fibrillation is the most common cardiac rhythm disturbance encountered by physicians in clinical practice. 1 Atrial fibrillation is characterized by uncoordinated atrial activation, and if not managed appropriately, may be associated with significant morbidity and mortality and a reduction in quality of life. 2 It is estimated that 2.3 million Americans and 4.5 million Europeans are affected by atrial fibrillation, which predominantly impacts persons Ͼ65 years of age. 2 By the year 2050 it is estimated that more than 5.5 million people in the United States will have atrial fibrillation. 1 Atrial fibrillation presents in specific patterns and can be classified as paroxysmal (self-terminating and lasting Ͻ7 days), persistent (not self-terminating and lasting Ͼ7 days), and permanent (lasting Ͼ1 year and/or refractory to cardio-version). 3 Paroxysmal atrial fibrillation and persistent atrial fibrillation are not mutually exclusive, and individuals may experience both at different times. A patient's atrial fibril-lation often is characterized based on the most frequent or most sustained presentation. Well-known risk factors for atrial fibrillation include coronary artery disease (CAD), diabetes, heart failure, hypertension, hyperthyroidism, and myocardial infarction. 4 In animal models, atrial fibrillation has been shown to cause electrophysiologic changes in the atrium, including marked shortening of the atrial effective refractory period. 5,6 With continued atrial fibrillation, contractile and structural remodeling occurs, and atrial fibrillation can become self-sustained, no longer requiring a trigger. 5,7,8 Electrical , contractile, and structural changes also have been observed in humans, and it has been noted that the duration of atrial fibrillation tends to correlate well with the progression of these changes. 9-12 In addition to shortening of the atrial effective refractory period, several other factors have been associated with structural remodeling in atrial fibrilla-tion. These include aging, alcohol consumption, autonomic