Contemporary Management of Atrial Fibrillation: Update on Anticoagulation and Invasive Management Strategies

Crandall, Mark A.; Bradley, David J.; Packer, Douglas L.; Asirvatham, Samuel J.

doi:10.4065/84.7.643

Cited by 31 publications

(10 citation statements)

References 201 publications

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“…While approximately half of these patients remain asymptomatic, nearly 30% require a second procedure and 10-25% require additional pharmacological therapy in order to maintain normal sinus rhythm post ablation therapy 14, 15. However, the long-term effectiveness of this technique remains to be fully determined 16, 9…”

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confidence: 99%

Ion channel trafficking: A new therapeutic horizon for atrial fibrillation

Schumacher

Martens

2010

Heart Rhythm

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Atrial fibrillation (AF) is a common cardiac arrhythmia with potentially life-threatening complications. Drug therapies for treatment of AF that seek long-term maintenance of normal sinus rhythm remain elusive due in large part to proarrhythmic ventricular actions. Kv1.5, which underlies the atrial specific I Kur current, is a major focus of research efforts seeking new therapeutic strategies and targets. Recent work has shown a novel effect of antiarrhythmic drugs where compounds that block Kv1.5 channel current can also alter ion channel trafficking. This work further suggests that the pleiotropic effects of antiarrhythmic drugs may be separable. Although this highlights the therapeutic potential for selective manipulation of ion channel surface density, it also reveals an uncertainty regarding specificity of modulating trafficking pathways without risk of off-target effects. Future studies may show that specific alteration of Kv1.5 trafficking can overcome the proarrhythmic limitations of current pharmacotherapy and provide an effective method for long-term cardioversion in AF. KeywordsCardiovascular; Atrial fibrillation; Cardioversion; Kv1.5; Trafficking; Channels Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia affecting an estimated 2.2 million adults in the in the United States. 1 AF is caused by the rapid and irregular activation of the atria by electrical sources outside the normal sinus node, and can be classified as paroxysmal, persistent, or long-standing persistent. 2 The occurrence of atrial fibrillation increases dramatically with age, affecting less than 1% of individuals under age 50 to approximately 10% of individuals over age 80. 1,3 Importantly, over the past two decades the age standardized death rate (per 100,000 in the US) has increased from 27.6 to 69.8. 4 Therefore, AF presents a significant increasing health risk with an untold burden for healthcare costs.The combination of inefficient atrial contraction and irregular ventricular rate can lead to serious complications. AF related deaths are due primarily to the increased risk of stroke and heart failure. AF is associated with a nearly 5-fold increase in the risk of embolic stroke with nearly one fourth of all strokes in patients over 80 attributable to AF. 5,6 This increased rate of stroke is due to the rapid, uncoordinated atrial rhythm that leads to inefficient contraction © 2010 The Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.Correspondence should be addressed to: Jeffrey R. Martens, Department of Pharmacology, 1301 MSRBIII, 1150.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal d...

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confidence: 99%

Ion channel trafficking: A new therapeutic horizon for atrial fibrillation

Schumacher

Martens

2010

Heart Rhythm

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“…(78)(79)(80) There are also multiple issues concerning maintenance of target INR. (73,74,81) Several series have highlighted the difficulties of maintaining the INR in the therapeutic range, 29% of patients are said to be subtherapeutic on warfarin, while 15% are supratherapeutic. (82) Such issues have led to significantly higher rates of bleeding, mortality and stroke in patients with AF.…”

Section: Limitations Of Medical Therapy For Afmentioning

confidence: 98%

“…(73,74) There are major limitations to the use of warfarin; these range from the multiple food and drug interactions, its narrow therapeutic window, frequent monitoring and dose adjustments and substantial fatal bleeding consequences. The annual bleeding risk for warfarin has been estimated at 0.6% for fatal bleeds, 3% for major bleeds and 9.6% for all bleeds.…”

Section: Limitations Of Medical Therapy For Afmentioning

confidence: 99%

Left Atrial Appendage Occlusion for Stroke Prevention

Alli¹,

Holmes²

2015

Current Problems in Cardiology

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“…6 The aim of physicians managing atrial fibrillation patients is to reduce the possibility of incurring in thromboembolic events by antiaggregant or anticoagulant therapy, according to individualized risk. 4 Consequently, to improve quality of life and reduce symptoms, 7 an attempt to restore and maintain sinus rhythm should be undertaken. To reach this goal the starting approach is pharmacological treatment: the success rate is, however, low and complication rates are high.…”

Section: Introductionmentioning

confidence: 99%

History of transcatheter atrial fibrillation ablation

Anselmino

D’Ascenzo

Amoroso

et al. 2012

Journal of Cardiovascular Medicine

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Transcatheter atrial fibrillation ablation has undergone an impetuous advance over the past decades, reaching satisfactory results concerning safety and medium-term efficacy. Several experimental studies have paved the way both to new ablative procedures and technologies development. The present work reviews the history of transcatheter atrial fibrillation ablation, offering a wide view of current catheter-delivered atrial fibrillation procedures.

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Contemporary Management of Atrial Fibrillation: Update on Anticoagulation and Invasive Management Strategies

Cited by 31 publications

References 201 publications

Ion channel trafficking: A new therapeutic horizon for atrial fibrillation

Ion channel trafficking: A new therapeutic horizon for atrial fibrillation

Left Atrial Appendage Occlusion for Stroke Prevention

History of transcatheter atrial fibrillation ablation

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