Atrial Fibrillation-The Final Frontier

Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and represents a significant health care issue. The diagnosis and management of AF uses a significant proportion of the health care budget and is responsible for substantial morbidity and mortality. Restoration and maintenance of sinus rhythm is still an important treatment option for symptomatic AF. Anti-arrhythmic drugs (AADs) have had inconsistent results for the prevention of recurrent AF and have been hampered by significant adverse effects. Catheter ablation has rapidly evolved and is fast becoming an alternative for AF prevention. Although multiple treatment options exist, no single modality is effective for all patients. This review outlines best current practice for AF prevention and future perspectives, focusing on new and promising developments in antiarrhythmic drug therapy, strategies for ablation therapy, and forms of hybrid therapy that may offer improved outcomes in selected patients.

Systematic Review and Meta-analysis of the Efficacy of Cardioversion by Vernakalant and Comparators in Patients with Atrial Fibrillation

“…Although existing evidence does not show one approach to be clearly superior to the other [10][11][12][13][14][15], in AF patients with distressing symptoms and/or seriously compromised cardiac function, it is of particular interest that cardioversion be achieved rapidly [5][6][7][8]16], as delayed cardioversion may worsen AF-associated symptoms and promote structural remodeling of the atria [17]. While various cardioversion therapies exist, their limitations, including limited use in certain comorbid patients, drug-drug interactions, and slow cardioversion rates, highlight the need for new treatments that are safer, more effective, and more timely in action [6,[18][19][20][21][22][23][24][25][26][27][28].…”

Association Between Outpatient Visits Following Hospital Discharge and Readmissions Among Medicare Beneficiaries With Atrial Fibrillation and Other Chronic Conditions

“…9 People with AF generally have multiple other chronic conditions, a lower quality of life, a higher incidence of complications (particularly stroke), a higher mortality rate, and greater health care costs than patients with other forms of cardiovascular disease. [10][11][12][13] Because such a large fraction of those with AF are older than age 65, CMS bears a large portion of the significant burden-in terms of both cost and health outcomes-for this population. For example, Medicare beneficiaries with AF are estimated to have higher rates of inpatient hospitalizations than those without AF.…”

Hybrid approach to treatment of atrial fibrillation

“…The hybrid approach of combining endocardial and epicardial ablation to the treatment of AF was then discussed 2005 by Bisleri et al [9] and subsequently introduced in 2007 by Pak et al [10]. However, it is only a recent trend toward the use of this approach to treating cardiac arrhythmias [11] that has been gaining popularity [12], especially for the treatment of persistent AF [13].…”

“…. However, it is only a recent trend toward the use of this approach to treating cardiac arrhythmias that has been gaining popularity , especially for the treatment of persistent AF .…”