Management of atrial fibrillation-flutter: uptodate guideline paper on the current evidence

Abstract

The term ‘flutter’ and ‘fibrillation’ were first coined to differentiate the differences between fast, regular contractions in Atrial Flutter (AFLUT) with irregular, vermiform contractions of Atrial Fibrillation (AFIB). Management of these two diseases has been a challenge for physicians. Rate control (along with rhythm control) is the first line of management for symptomatic AFIB/AFLUT with Rapid Ventricular Rate (RVR). In some situations, atrial rhythms may not be well controlled by these anti-arrhythmic drugs, making cardioversion to sinus rhythm necessary. Anti-coagulation therapy in both the disease population is essential. Catheter ablation is an effective treatment option in certain patients that have AFIB/AFLUT refractory to medical management. Newer techniques like left atrial appendage (LAA) has been developed and is a highly attractive concept for the future in the management of AFIB/AFLUT. Newer novel drugs targeting specific ion channels are approaching the stages of clinical investigation. However, while advances in technologies have helped elucidate many aspects of these diseases, many mysteries still remain. This literature review serves as one of the guideline papers for current up-to-date management on both AFIB and AFLUT.

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and cardiac arrhythmias: a systematic review and meta-analysis

“…Larger RCTs powered to detect differences in AFL are required to confirm these findings. Nevertheless, AF and AFL have similar clinical significance and consequences, [ 53 ] and the conjoint analysis of AF/AFL, which shows a significant risk reduction, provides more robust results while obviating possible publication bias for AFL.…”

Atrial fibrillation and atrial flutter – the state of the art. Part 1

“…It is estimated that 1 in 4 middle-aged adults in Europe and the US will have AF [13] and by 2030 there will be 14-17 million individuals with AF in Europe with 120-215 thousand new cases each year (incidence of 0.23-0.41 per 1000 person/years) [14]. According to estimates the incidence rate will double by 2050 [15]. AF more frequently develops in older adults and in patients with arterial hypertension (HA), HF, coronary artery disease (CAD), valvular heart diseases, obesity, diabetes mellitus (DM), and chronic kidney disease (CKD) [12].…”

Atrial Flutter: up‐to‐date Problem Evaluation with Clinical Positions

“…Наименее эффективным для контроля частоты желудочковых активаций является дигоксин, но его применение оправдано при выраженной ХСН и артериальной гипотензии. Целевой контроль частоты ТП может быть достигнут путем комбинации перечисленных препаратов: бета-адреноблокаторов или антагонистов кальция с дигоксином или амиодароном, а также амиодарона с дигоксином [43]. В то же время, по данным German Ablation Registry [44] [50,52].…”