Atrial fibrillation: review of current treatment strategies

Abstract

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in modern clinical practice, with an estimated prevalence of 1.5-2%. The prevalence of AF is expected to double in the next decades, progressing with age and increasingly becoming a global medical challenge. The first-line treatment for AF is often medical treatment with either rate control or anti-arrhythmic agents for rhythm control, in addition to anti-coagulants such as warfarin for stroke prevention in patient at risk. Catheter ablation has emerged as an alternative for AF treatment, which involves myocardial tissue lesions to disrupt the underlying triggers and substrates for AF. Surgical approaches have also been developed for treatment of AF, particularly for patients requiring concomitant cardiac surgery or those refractory to medical and catheter ablation treatments. Since the introduction of the Cox-Maze III, this procedure has evolved into several modern variations, including the use of alternative energy sources (Cox-Maze IV) such as radiofrequency, cryo-energy and microwave, as well as minimally invasive thoracoscopic epicardial approaches. Another recently introduced technique is the hybrid ablation approach, where in a single setting both epicardial thoracoscopic ablation lesions and endocardial catheter ablation lesions are performed by the cardiothoracic surgeon and cardiologist. There remains controversy surrounding the optimal approach for AF ablation, energy sources, and lesion sets employed. The goal of this article is review the history, classifications, pathophysiology and current treatment options for AF.

Clinical outcomes of adjunctive posterior wall isolation in persistent atrial fibrillation: A meta‐analysis

“…Atrial fibrillation (AF) is the most common arrhythmia, with a prevalence of 0.5% to 1% of the population, 1 and is expected to rise even more over the next decades 2 . Historically management of AF has been geared toward rate control, or rhythm control with antiarrhythmic drugs.…”

The trends and prevalence of obesity and morbid obesity among Australian school‐aged children, 1985–2014

“…Negative cultural prejudices towards individuals with obesity further contribute to psychosocial problems such as depression . Childhood obesity can also have lasting impacts on health, with children who are obese being more likely to be obese as an adult and at greater risk of high blood pressure, heart diseases, type 2 diabetes and stroke . These diseases are a significant economic burden on the health‐care system, and thus, it is important to monitor childhood trends in obesity and morbid obesity to guide preventative interventions.…”

Effectiveness and safety of simultaneous hybrid thoracoscopic endocardial catheter ablation of atrial fibrillation in obese and non-obese patients

“…The hybrid approach has been introduced in an attempt to improve results in catheter ablation and surgical ablation alone (21,22). This approach combines the advantages of both catheter and surgical ablation approaches, with a procedure that produces superior transmural lesions epicardially, whilst allowing endocardial identification of ablation targets to customize lesion sets and endocardial touch-ups to close conduction gaps.…”