Modern management of atrial fibrillation

Abstract

-Atrial fibrillation (AF) continues to offer a management challenge to physicians. The incidence of this arrhythmia is rising and the cost to the healthcare system is vast. Much of this health burden relates to the high risk of stroke and thromboembolism associated with AF. This review covers common treatment strategies employed in AF management, discusses relevant drug therapy and the role of electrophysiology or surgery.KEY WORDS: antiarrhythmic drugs, atrial fibrillation, stroke, thromboembolic prophylaxis IntroductionAs the most common arrhythmia encountered in clinical practice and with rapidly evolving treatment strategies, atrial fibrillation (AF) continues to offer a management challenge to the physician. This emerging health epidemic is reflected by AF now consuming approximately 1% of NHS expenditure.Cross-sectional studies have shown that the prevalence and incidence of AF continues to surge, correlating in particular with the advancing age of Western populations. In those over 65, approximately 5% have AF, while in those aged over 80 years, this figure rises to 10%.This review focuses on management of AF with reference to the National Institute for Health and Clinical Excellence (NICE) evidence-based clinical guidelines published in June 2006. 1 In addition, the American College of Cardiology/American Heart Association/European Society of Cardiology consensus guidelines for the management of patients with AF have also now been updated. 2 Risk factors for atrial fibrillationMany risk factors for AF have been identified. As well as advancing age, there is a strong link with hypertension, ischaemic heart disease, structural/functional heart disease, valvular heart disease and hyperadrenergic states (such as thyrotoxicosis or illicit drug use), to name but a few. In some patients, alcohol excess may provide an adequate trigger for acute AF.In fact, the array of associations with AF is enormous (Box 1) and in part explains why a detailed knowledge of this condition is essential for both the generalist and specialist alike; not only will cardiologists frequently encounter AF, but so will colleagues in other specialties. Symptoms and presentationThe incidental finding of asymptomatic AF remains relatively common, often detected for example during preoperative assessment. Increasingly, though, AF is diagnosed during investigation for symptoms such as palpitations, dyspnoea, dizziness or syncope. This list is by no means exhaustive and it is increasingly recognised that AF contributes to or exacerbates numerous complaints, including lethargy, fatigue and anxiety. Additionally, it is important to remember that other conductive or atrioventricular nodal diseases may coexist with AF and in those who complain of syncopal episodes this should be considered as a co-diagnosis. Box 2 illustrates the most common symptoms reported in association with AF. ClassificationThe classification of AF has been through a period of change. Most are now agreed on a clinical classification system, based on the temporal pat...

The relationships between uncertainty and its antecedents in Korean patients with atrial fibrillation

“…Among many clinical populations, patients with atrial fibrillation were identified as one of the high‐risk groups for reporting uncertainty that resulted in negative outcomes including anxiety, depression and low perceived health (Kang 2002). Although atrial fibrillation is the most common cardiac rhythm disturbance in clinical practice, the treatments of this disorder are very complicated, and no single accepted approach to the management of atrial fibrillation exists (Watson et al. 2007).…”

Atrial Fibrillation’s Influence on Short Sleep Duration Increases the Risk of Fatness in Management Executives

“…According to prevalence surveys, approximately 2% of the population has AF, and its incidence increases with age [14]. The mechanism that causes AF is generally believed to be the extremely rapid abnormal discharges in the atrial tissue, resulting in the inability of the atria to contract normally and irregular heartbeat [15]. AF is caused by the atrium replacing the sinus node that normally sends out electrical signals, resulting in a rapid and disorderly heartbeat during the attack [16].…”

Incomplete endothelialization of WatchmanTM Device: Predictors and Implications from Two Cases

“…Atrial fibrillation (AF) isas regarded as the most common heart arrhythmia which is seen in clinical pratctice [16,17] . Atrial fibrillation can induce or exacerbate heart failure, myocardial infarction, thromboembolism, cerebral infarction [18] and chronic renal failure [19] , which all negatively affect the quality of life and increase the duration of hospital stay [20,21] . More than 1% of adults develop AF, and the prevalence of AF increases with age [22] .…”

“…Also, over 2 million people in the United States suffer from AF. The cost of continuous examinations and increased rates of hospitalization of AF patients amounted to 459 million Euro in 2000 [20,21,23,24] . Predictions suggest that the world will face a 2.5-fold increase in the prevalence of AF by the year 2050 [25] .…”

“…Considering the importance of AF and its socioeconomic burden, it is necessary to identify the risk factors which crucially contribute to this condition. Many studies demonstrated associations between some predisposing factors like gender, age, hypertension, diabetes, smoking, heart's valve defects, myocardial infarction, heart failure and sleep-disordered breathing, and the incidence of AF [20,21,23,24] . Though there is some evidence for possible association between sleep duration and the incidence of AF, there is considerable controversy with respect to the result of the related studies.…”