Contemporary therapy of atrial fibrillation

Abstract

Atrial fibrillation (AF) is estimated that by 2010, approximately 2.6 million people will be affected in USA; by 2050, that number may increase to 10 million patients. Generally, rate control alone is reasonable in some AF patients, especially asymptomatic patients. Restoration and maintenance of sinus rhythm (SR) may be achieved by means of cardioversion, drugs or/ and catheter ablation. Pharmacological therapy can be useful to maintain SR and prevent tachycardia-induced cardiomyopathy. All patients with AF regardless of whether a rhythm or rate control strategy recommend anticoagulant, antiplatelet or both combined therapy for prevention of thromboembolism, except those with lone AF or contraindications. Drug selection should be based upon the absolute risk of stroke, bleeding, the relative risk and benefit for a given patient. Biventricular pacing may overcome many of the adverse hemodynamic effects associated with RV pacing alone. A target individual ectopic foci ablation within the pulmonary vein (PV) has evolved to circumferential electrical isolation of the entire PV musculature. Cavotricuspid isthmus should be considered as first-line therapy for patients with typical atrial flutter. Completely non-fluoroscopic ablation guided by Real-Time Magnetic Resonance Imaging (RTMRI) using a steerable and non-ferromagnetic catheter is a promising novel technology in interventional electrophysiology

Perioperative Arrhythmias and Acute Right Heart Failure in Noncardiac Thoracic Surgery

“…In the presence of one moderate risk factor (such as age C75, hypertension, chronic heart failure), aspirin and/ or vitamin K antagonists are recommended. In the presence of any high risk factor (previous stroke, transient ischemic attack or embolism, mitral stenosis, prosthetic valve) or more than one moderate risk factor, vitamin K antagonists are recommended, with a target INR of 2-3 [53]. Subcutaneous unfractionated heparin or low molecular weight heparin can be used as a bridge to vitamin K antagonists in the immediate postoperative period in patients not at risk for bleeding.…”