The CHADS2 score is a powerful predictor of stroke and death. AF increases the risk of these outcomes in an independent manner. These data support the concept that AF is a risk factor of future cardiovascular disease.

Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Its increasing prevalence, particularly among the elderly, renders it one of the most serious current medical epidemics. Several management questions confront the clinician treating a patient with AF: Should the condition be treated? Is the patient at risk of death or serious morbidity as a result of this diagnosis? If treatment is necessary, is rate control or rhythm control superior? Which patients need anticoagulation therapy, and for how long? This review of articles obtained by a search of the PubMed and MEDLINE databases presents the available evidence that can guide the clinician in answering these questions. After discussing the merits of available therapy, including medications aimed at controlling rate, rhythm, or both, we focus on the present status of ablative therapy for AF. Catheter ablation, particularly targeting the pulmonary veins, is being increasingly performed, although the precise indications for this approach and its effectiveness and safety are being actively investigated. We briefly discuss other invasive options that are less frequently used, such as pacemakers, defibrillators, left atrial appendage closure devices, and the surgical maze procedure.

Risks factors associated with AF were associated with higher hs-CRP in an incremental manner. The presence of AF increased hs-CRP across the CHADS2 score strata is supportive of the concept that AF is an inflammatory process and may convey independent risk.

This review focuses on the recent progress in and future prospects for the widened use of biomarkers of inflammation to modify lipid treatment goals in individuals assessed according to traditional risk factors to be at moderate or higher risk for clinical cardiovascular disease events. Elevated blood levels of high-sensitivity C-reactive protein or lipoprotein-associated phospholipase A(2) independently predict increased risk after adjustment for an individual's clinical risk status. When elevated individually, each is associated with an approximate doubling of risk for primary or recurrent cardiovascular events. Fourteen major studies, encompassing healthy adults, patients with chronic coronary heart disease, and those with a recent coronary event or stroke, are reviewed, demonstrating the consistent predictive value of these biomarkers across the risk spectrum. When both inflammatory markers are increased, they provide an even greater predictive capability to identify especially high-risk individuals who would benefit most from aggressive lipid-modifying therapies.

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Percutaneous Radiofrequency Catheter Ablation. Patients with an atrial septal defect (ASD) commonly have atrial fibrillation (AF) and closure of the ASD rarely controls the arrhythmia. We report on the management of 4 patients with recurrent medically refractory AF in the setting of an unrepaired ASD who underwent percutaneous RFA prior to ASD closure. In 3 of the 4 patients AF was controlled after ablation without antiarrhythmic drug therapy and in the fourth patient AF was controlled with antiarrhythmic therapy after ASD closure. Based on these limited results it seems reasonable to consider RFA of medically refractory AF in patients prior to planned percutaneous ASD closure.

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A 68-year-old woman with a history of hypertension, paroxysmal atrial fibrillation, and liver transplant for primary sclerosing cholangitis (PSC) presented with a 2-month history of cough and shortness of breath. Her cough, which had gradually worsened, progressed to dyspnea after several feet of walking. She denied fever, chills, sick contacts, chest pain, palpitations, orthopnea, and paroxysmal nocturnal dyspnea. She had taken levofloxacin for a presumed upper respiratory tract infection with no relief and was receiving oral immunosuppressive therapy with 1 mg/d of prednisone and 25 mg of cyclosporine twice daily. Her other medications included losartan, metoprolol, mesalamine, and alendronate. Although she had no history of cardiac problems, examination revealed a mildly elevated jugular venous pressure (JVP) and trace peripheral edema.