Atrial fibrillation: strategies to control, combat, and cure (original) (raw)

Atrial fibrillation: Epidemiology, mechanisms, and management

Current Problems in Cardiology, 2000

~ ften associated with an adverse prognosis, atrial fibrillation (AF) is a common and troublesome arrhythmia, 1-22 and its electrocardiographic (ECG) characteristics are relatively well recognized. It is characterized by chaotic, rapid, discontinuous atrial depolarizations, resulting in rapid oscillations that are recorded as irregularly formed f waves in contrast to uniform P waves of sinus or other distinct supraventricular rhythms (Fig 1). AF is a dysrhythmia of the atria, in which the atria stop contracting as they begin to fibrillate, or quiver, and become ineffectual in filling the ventricles, disrupting ventricular function, and subsequently, cardiac output. When sinus rhythm ceases to be the heart's driving force, ventricular responses also become irregular, reflecting the atrium's chaotic electrical activity. The ventricular irregular contractions, which have become either too fast or too slow, impair the cardiac pump, leading to a variety of symptoms usually attributable to these hemodynamic variances. Even patients with asymptomatic AF have high incidences of such complications as stroke, congestive heart failure (CHF), and cardiomyopathy. The degree of irregularity in ventricular rate depends on several factors, including innate properties of the atrioventricular (AV) node, levels of sympathetic or parasympathetic stimulation, and whether therapies are aimed at treating AF through modifying properties of the AV node or those of the atria, or are simply aimed at treating concomitant conditions. Although certain populations are more prone than others to develop AF, its causes and mechanisms are not easily understood, and the terminology for its classification varies significantly. 2m2 The following classification system is used for this review: Paroxysmal: Episodes are <7 days long, interspersed with periods of sinus rhythm, and (the hallmark of paroxysmal AF) usually terminate spontaneously (paroxysmal AF, although self-terminating, may be recurrent). Persistent: Intervention is needed to restore sinus rhythm. Permanent or chronic: No spontaneous conversion; interventions to restore sinus rhythm are either ineffectual or not tried. At any given time, the classification of an AF, and hence the proper treatment protocol, falls somewhere on the above spectrum. Data from the Cardiovascular Atrial septal defect Cardiac surgery disease Cardiomyopathy: hypertrophic Idiopathic Infiltrative Hypertension Ischemic heart disease: acute and chronic Alcohol ("holiday heart" syndrome) Cerebral vascular accident Chronic pulmonary disease Defibrillation Effort Electrocution Electrolyte abnormalities Rare Acute hypovolernia Congenital Multiple sclerosis Muscular dystrophy Mltral valve prolapse Nonrheumatic mitral or tricuspid valve disease Pericarditis Rheumatic heart disease Tachycardia-bradycardia syndrome Tumors, lipomatous or hypertrophic Wolff4~arkinson-W hlte syndrome Fever Hypothermia Pneumonia Pulmonary embolism Sudden emotion Thyrotoxicosis Trauma Pheochromocytoma Right atrial cold injection Swallowing Tyramine-containing foods From Stanton MS, Miles WM, Zipes DO. Atrial fibrillation and flutter. In: Zipes DP, Jalife J, editors. Cardiac electrophysiology from cell to bedside. Philadelphia: WB Saunders; 1990. p. 735-42. infarction (MI) 18.23 and may be self-limiting. In the CARAF study, 198 (18.2%) of 1086 patients who were entered into the registry during 1991-1995 developed AF after open-heart surgery, whereas the AF of the remaining 888 was not surgically related. Noncardiac conditions associated with AF include, but are not limited to, hyperthyroidism, diabetes mellitus, alcohol intoxication, use of cholinergic drugs, and pulmonary diseases, as are such factors as exercise, emotional stress, fever, electrocution, hypothermia, trauma, and muscular dystrophy (Table 1). 11,24-29 Much of our knowledge about the incidence of AF is derived from the Framingham Study, which despite possible limitations of ethnic and racial bias related to the population studied, remains one of the single most important references for AE When the study started, there were 2090 men and 2641 women, ages 55 to 94 years. Thirty-eight years later, in 1994, 11.8% (562 patients) had documented AF, of whom 53% (298) were women. The incidence was higher in men (12.6%) than in women (11.3%). A 1991 report from this study noted that AF was more prevalent in older adults (ages 80 to 89), a 9% incidence, than in younger ones (ages 50 to 59), a 0.5% incidence, and this relationship continued in 1994, when there were 6.2 cases of AF documented for every 1000 examinations in

Current issues in atrial fibrillation

ISRN cardiology, 2012

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. It places an enormous burden on the patients, caregivers, and the society at large. While the main themes in the care of an AF patient have not changed over the years and continue to focus on stroke prevention, control of the ventricular, rate and rhythm maintenance, there have been a number of new developments in each of these realms. This paper will discuss the "hot" topics in AF in 2012 including new and upcoming medical and invasive management strategies for this condition.

Management of atrial fibrillation

Current problems in cardiology, 2005

Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. It is common in the elderly and those with structural heart disease. Clinical classification can be helpful in treatment decisions and the most widely accepted classification scheme (first episode, recurrent paroxysmal, recurrent persistent, permanent) is found in the ACC/ AHA/ESC guidelines.

Current Strategies in the Management of Atrial Fibrillation

2010

Treatment of atrial fibrillation (AF) has been undergoing significant changes recently. This is due partly to different mechanisms proposed for persistent and permanent AF and partly due to the introduction of energy-based techniques, providing less invasive procedures. This article aims to review the mechanisms of AF leading to the changes in clinical practice and to review the results of surgery, energy-based, and percutaneous techniques.

Atrial fibrillation: Challenges and opportunities

Canadian Journal of Cardiology, 2006

A trial fibrillation (AF) is the most common sustained arrhythmia treated by physicians today. Despite decades of investigation and experience with the treatment of AF, many challenges remain. Contemporary challenges include the following examples: an incomplete understanding of the pathophysiology of AF; an increasing prevalence of AF; a lack of efficacy of and the presence of adverse effects from antiarrhythmic drug therapy; and suboptimal use of antithrombotic therapy for the prevention of stroke and thromboembolism. On the other hand, each of these challenges is associated with a number of opportunities for improved understanding and management of this vexing problem. The present overview will explore each of the challenges in the management of AF listed above and some of the opportunities associated with them.

Atrial fibrillation: current concepts

International journal of health sciences, 2008

Atrial fibrillation (AF) is the most common arrhythmia which is a focus of newer modalities of treatment, especially ablation techniques using innovative mapping techniques. Its incidence and prevalence increases with aging and presence of structural heart disease, the latter being less than 1% prior to age 40, rising to 8% at age 80. Concomittant morbidity and excessive mortality is related to the increased incidence of stroke and congestive heart failure. Once developed in a clinical setting, it tends to either persist or recur. Pharmacotherapy to control rate or rhythm tends to have a secondary failure, and therefore there is a growing interest in ablation techniques. The use of anticoagulation is also associated with bleeding risks and therefore the management of AF needs to be individualized in every patient. In this article, we shall be discussing clinical types of AF, etiology, the mechanism of genesis, symptoms, complications and approach to treatment in various clinical sce...