Alternatives to chronic warfarin therapy for the prevention of stroke in patients with atrial fibrillation

Lam, Yat‐Yin; K.W., Terry; Yan, Bryan P.

doi:10.1016/j.ijcard.2010.10.017

Cited by 26 publications

(12 citation statements)

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“…60 The primary role of the LA appendage is consistent with the predictive value of LA thrombus on echocardiography and with the usefulness of LA exclusion procedures in thromboembolism prevention. 89 Our present understanding of atrial thromboembolism places great importance on the consequences of atrial dysrhythmia. Several clinical observations raise questions about this notion.…”

Section: Prevention Of Thromboembolismmentioning

confidence: 99%

Atrial Fibrillation Pathophysiology

et al. 2011

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Abstract-Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, is an important contributor to population morbidity and mortality. An arrhythmia that is particularly common in the elderly, AF is growing in prevalence with the aging of the population. Our understanding of the basic mechanisms that govern AF occurrence and persistence has been increasing rapidly. This article reviews the basic pathophysiology of AF over a broad range of levels, touching on the tissue mechanisms that maintain the arrhythmia, the relationship between clinical presentation and basic mechanisms, ion channel and transporter abnormalities that lead to ectopic impulse formation, basic models and tissue determinants of reentry, ion channel determinants of reentry, the nature and roles of electric and structural remodeling, autonomic neural components, anatomic factors, interactions between atrial and ventricular functional consequences of AF, and the basic determinants of atrial thromboembolism. We then review the potential implications of the basic pathophysiology of the arrhythmia for its management. We first discuss consequences for improved rhythm control pharmacotherapy: targeting underlying conditions, new atrium-selective drug targets, new targets for focal ectopic source suppression, and upstream therapy aiming to prevent remodeling. We then review the implications of basic mechanistic considerations for rate control therapy, AF ablation, and the prevention of thromboembolic events. We conclude with some thoughts about the future of translational research related to AF mechanisms. (Circulation. 2011; 124:2264-2274.)Key Words: antiarrhythmia agents Ⅲ arrhythmia Ⅲ calcium Ⅲ electrophysiology Ⅲ reentry A trial fibrillation (AF), the most common sustained cardiac arrhythmia, is becoming progressively more prevalent with population aging. 1 Enormous advances in the understanding of AF pathophysiology have occurred over the past 20 years. 2,3 The present article, part of a thematic series in Circulation on AF, provides a broad overview of AF pathophysiology and the potential implications for AF management. In addition, it furnishes background information on basic mechanisms relevant to other articles in the series dealing with AF epidemiology and genetics, stroke prevention, rate control therapy, sinus rhythm maintenance pharmacotherapy, management in structural heart disease, and catheter ablation. For more comprehensive treatment of specific mechanisms, the reader is referred to detailed review articles. [2][3][4][5]

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Section: Prevention Of Thromboembolismmentioning

confidence: 99%

Atrial Fibrillation Pathophysiology

et al. 2011

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“…The risk of ischemic stroke in a patient with nonvalvular AF is 5% per one year [1]. Left atrial appendage (LAA) is the most common site of thrombus formation in these patients [2]. ST-segment elevation myocardial infarction (STEMI) related to cardiogenic embolisation of coronary arteries is a rare finding and its prevalence remains unknown.…”

Section: Letter To the Editormentioning

confidence: 99%

“…It may occur within the first 2 weeks, but also as early as in the first 24 h. Cardioembolic stroke related to intraventricular thrombi is observed more frequently in patients with anterior wall infarction and extensive akinesia of the apex [5,6]. On the other hand, intraatrial thrombi develop mostly in patients with permanent or paroxysmal AF [2]. Single cases of STEMI in patients with AF caused by intraatrial thrombi embolisation were reported [7].…”

Section: Letter To the Editormentioning

confidence: 99%

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Cardioembolic acute myocardial infarction and stroke in a patient with persistent atrial fibrillation

Kleczyński

Dziewierz

Rakowski

et al. 2012

International Journal of Cardiology

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“…Valvular heart disease is found in *30% of AF patients [4,5]. While most of the literature refers generically to ''valvular'' and ''non-valvular'' etiologies, only the presence of (rheumatic) mitral stenosis has been demonstrated to increase the incidence (and extra-LAA location) of atrial thrombi in AF.…”

mentioning

confidence: 99%