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

Abstract

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.

Prevention of Cardioembolic Stroke

“…Newer surgical or interventional options are described for AFand include the Maze procedure, and other atrial occluder interventions, including the WATCHMAN, PLAATO, and Amplatzer devices [74,75]. These devices are typically used in AF patients who cannot tolerate prolonged anti-coagulation therapy.…”

“…These devices also carry initial surgical or endovascular risks not seen with medical therapy. Although these interventions have shown feasibility, their long-term superiority to medical management remains a matter of debate [74,75]. It appears to Table 4 Consensus treatment recommendations for patients with AF combined with CHADS2 score equivalents* ► Aspirin 81-325 mg daily for patients with no risk factors or contraindication to warfarin ► Aspirin 81-325 mg daily or warfarin (INR: 2-3) for patients with one moderate risk factor (i.e.…”

Current management of atrial fibrillation

“…[6][7][8] The ventricular rate may be controlled using beta blockers, non-dihydropyridine calcium channel blockers (for example verapamil) or digoxin. 1,3,5 However, beta blockers should be avoided in patients with asthma, and digoxin and calcium channel blockers should be avoided in those with pre-excitation.…”

“…[3][4][5] Symptoms include palpitations, dizziness, dyspnoea, angina and worsening heart failure. 1,3,5 Atrial fibrillation may be categorised according to its presentation (initial, paroxysmal or recurrent, persistent) and duration. 1 Its management depends on the assessment of thromboembolic risk and control of symptoms.…”

Analysis of antithrombotic therapy in elderly patients with atrial fibrillation

“…Atrial fibrillation (AF) is the most common arrhythmia observed in clinical practice (Crandall et al, 2009). The incidence of AF increases with age, and for elderly patients aged over 80 years, it can reach up to 10% (Go et al, 2001;Freestone and Lip, 2003).…”