scholarly journals Atrial thrombi in elective patients considered for atrial fibrillation rhythm control: Risk factors and prognostic value

2021 ◽  
Author(s):  
Marcella Cabral Caires ◽  
Roberto Muniz Ferreira ◽  
Thaís Fonseca Rodrigues ◽  
David Hong Kang ◽  
Lúcia Helena Alvares Salis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Prognostic Value ◽  
Rhythm Control ◽  
Atrial Thrombi ◽  
Elective Patients ◽  
Control Risk

Optimizing Heart Rate and Controlling Symptoms in Atrial Fibrillation

2016 ◽  
Vol 10 (1) ◽  
pp. 26
Author(s):  
Pragnesh Parikh ◽  
◽  
KL Venkatachalam ◽  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Rate Control ◽  
Stroke Risk ◽  
Symptom Control ◽  
Review Article ◽  
Rhythm Control ◽  
Ventricular Rate ◽  
Control Methods ◽  
Novel Approaches

Atrial fibrillation (AF) is the most common arrhythmia noted in clinical practice and its incidence and prevalence are on the rise. The single most important intervention is the evaluation and treatment of stroke risk. Once the risk for stroke has been minimized, controlling the ventricular rate and treating symptoms become relevant. In this review article, we emphasize the importance of confirming and treating the appropriate arrhythmia and correlating symptoms with rhythm changes. Furthermore, we evaluate some of the risk factors for AF that independently result in symptoms, underlining the need to treat these risk factors as part of symptom control. We then discuss existing and novel approaches to rate control in AF and briefly cover rhythm control methods.

scholarly journals Change in left atrioventricular coupling index to predict incident atrial fibrillation: the multi-ethnic study of atherosclerosis (MESA)

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
T Pezel ◽  
B Ambale Venkatesh ◽  
T Quinaglia ◽  
S Heckbert ◽  
YOKO Kato ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Prognostic Value ◽  
Discrimination Performance ◽  
Left Ventricular ◽  
Ethnic Population ◽  
Ethnic Study ◽  
C Statistic ◽  
Coupling Index ◽  
Traditional Risk Factors

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Left atrial (LA) and left ventricular (LV) structural and functional parameters have independent prognostic values as predictors of atrial fibrillation (AF). PURPOSE Due to the intrinsic physiological relationship between LA and LV, we sought to investigate the prognostic value of a left atrioventricular coupling index (LACI) as well as change in LACI to predict incident AF in a multi-ethnic population. METHODS In the Multi-Ethnic Study of Atherosclerosis (MESA), 1,911 study participants, free of clinically recognized AF and cardiovascular disease at baseline, had LACI assessed with CMR imaging at baseline (Exam 1, 2000–2002), and ten years later (Exam 5, 2010–2012). LACI was defined as the ratio of LA to LV end-diastolic volumes. Univariable and multivariable Cox proportional hazard models were used to evaluate the associations of LACI and average annualized change in LACI (ΔLACI) with incident AF. RESULTS Among the 1,911 participants (mean age 59 ± 9 years and 47.5% male participants), 87 incident AF events occurred over 3.9 ±0.9 years following the second imaging (Exam 5). After adjustment for traditional risk factors, greater LACI and ΔLACI were independently associated with AF (HR 1.69, 95% CI [1.46-1.96] and HR 1.71, 95% CI [1.50-1.94], respectively; both p < 0.0001). Adjusted models for LACI and ΔLACI showed significant improvement in model discrimination compared to currently used AF risk score model for predicting AF incidence (C-statistic: 0.78 vs. 0.74, and C-statistic: 0.80 vs. 0.74, respectively). The LACI and ΔLACI also showed superior discrimination performance for AF compared to the multivariable model including CHARGE-AF score, and individual LA or LV parameters. CONCLUSIONS Atrioventricular coupling (LACI) and coupling change (ΔLACI) are strong predictors for AF incidence in a multi-ethnic population. Both have incremental prognostic value for predicting AF over traditional risk factors, and superior discrimination power compared to the CHARGE-AF score and to individual LA or LV parameters.

scholarly journals Risk Factor Management in Atrial Fibrillation

2018 ◽  
Vol 7 (2) ◽  
pp. 118 ◽  
Author(s):  
Axel Brandes ◽  
Marcelle D Smit ◽  
Bao Oanh Nguyen ◽  
Michiel Rienstra ◽  
Isabelle C Van Gelder ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Management Strategy ◽  
Oral Anticoagulant Therapy ◽  
Rhythm Control ◽  
Current Evidence ◽  
Modifiable Risk Factors ◽  
Early Management ◽  
Risk Factor Management

Atrial fibrillation (AF) is the most common clinical arrhythmia and is associated with increased morbidity and mortality. There is growing evidence that numerous cardiovascular diseases and risk factors are associated with incident AF and that lone AF is rare. Beyond oral anticoagulant therapy, rate and rhythm control, therapy targeting risk factors and underlying conditions is an emerging AF management strategy that warrants better implementation in clinical practice. This review describes current evidence regarding the association between known modifiable risk factors and underlying conditions and the development and progression of AF. It discusses evidence for the early management of underlying conditions to improve AF outcomes. It also provides perspective on the implementation of tailored AF management in daily clinical practice.

scholarly journals Update on management of atrial fibrillation in heart failure: a focus on ablation

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318081
Author(s):  
Bart A Mulder ◽  
Michiel Rienstra ◽  
Isabelle C Van Gelder ◽  
Yuri Blaauw
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Symptomatic Relief ◽  
Critical Evaluation ◽  
Rhythm Control ◽  
Rate Versus ◽  
Patients With Heart Failure ◽  
Post Hoc

Atrial fibrillation is increasingly encountered in patients with heart failure. Both diseases have seen tremendous rises in incidence in recent years. In general, the treatment of atrial fibrillation is focused on relieving patients from atrial fibrillation-related symptoms and risk reduction for thromboembolism and the occurrence or worsening of heart failure. Symptomatic relief may be accomplished by either (non-)pharmacological rate or rhythm control in combination with optimal therapy of underlying cardiovascular morbidities and risk factors. Atrial fibrillation ablation has been performed in patients without overt heart failure successfully for many years. However, in recent years, attempts have been made for patients with heart failure as well. In this review, we discuss the current literature describing the treatment of atrial fibrillation in heart failure. We highlight the early rate versus rhythm control studies, the importance of addressing underlying conditions and treatment of risk factors. A critical evaluation will be performed of the catheter ablation studies that have been performed so far in light of larger (post-hoc) ablation studies. Furthermore, we will hypothesise the role of patient selection as next step in optimising outcome for patient with atrial fibrillation and heart failure.

scholarly journals Atrial Fibrillation and Mortality: Prognostic Factors and Direction of Prevention

Kardiologiia ◽  
2021 ◽  
Vol 61 (2) ◽  
pp. 91-98
Author(s):  
A. V. Ardashev ◽  
Yu. N. Belenkov ◽  
M. Ch. Matsiukevich ◽  
V. A. Snezhitskiy
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Prognostic Factors ◽  
Catheter Ablation ◽  
Clinical Significance ◽  
Therapeutic Strategies ◽  
Rhythm Control ◽  
Causes And Risk Factors

This review focuses on major causes and risk factors for death of patients with atrial fibrillation (AF). The authors analyzed current therapeutic strategies for managing patients with AF with respect of their effects on prediction and mortality. Special attention is paid to the strategy of rhythm control and the clinical significance of catheter ablation in the treatment of patients with AF and heart failure.

scholarly journals Risk Factors for Stiff Left Atrial Physiology 1 Year After Catheter Ablation of Atrial Fibrillation

2021 ◽  
Vol 12 ◽  
Author(s):  
Jae-Hyuk Lee ◽  
Oh-Seok Kwon ◽  
Hee Tae Yu ◽  
Tae-Hoon Kim ◽  
Jae-Sun Uhm ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrial ◽  
De Novo ◽  
Control Method ◽  
Systolic Pressure ◽  
Rhythm Control ◽  
Diastolic Velocity

Catheter ablation is the most effective rhythm control method for patients with atrial fibrillation (AF); however, it inevitably causes atrial tissue damage. We previously reported that AF catheter ablation (AFCA) increases left atrial (LA) pressure without changes in symptom scores. We hypothesized that extensive LA ablation increased the risk of stiff LA physiology. We included 1,720 patients (69.1% male, 60.0 [53.0–68.0] years old, 66.2% with paroxysmal AF) who underwent de novo AFCA and echocardiography before and 1-year after the procedure. Stiff LA physiology was defined, when the amount of the estimated pulmonary arterial pressure increase between the pre-procedural and the 1-year post-procedural follow-up echocardiography was >10 mmHg and when right ventricular systolic pressure (RVSP) was >35 mmHg at 1-year follow-up echocardiography. The failed rhythm control within 1 year was defined as recurrent AF despite using anti-arrhythmic drugs or cardioversion within a year of AFCA. We explored the incidence and risk factors for stiff LA physiology and the rhythm outcome of AFCA. Among the 1,720 patients, 64 (3.7%) had stiff LA physiology 1 year after AFCA. Stiff LA physiology was independently associated with diabetes (odds ratio [OR], 2.36 [95% CI, 1.14–4.87], p = 0.020), the ratio of the peak mitral flow velocity of the early rapid filling to the early diastolic velocity of the mitral annulus (E/Em; OR, 1.04 [95% CI, 1.00–1.10], p = 0.049), LA pulse pressure (Model 2: OR, 1.05 [95% CI, 1.00–1.11], p = 0.049), low LA voltage (OR, 0.36 [95% CI, 0.18–0.74], p = 0.005), empirical extra-pulmonary vein (PV) LA ablation (OR, 2.60 [95% CI, 1.17–5.74], p = 0.018), and radiofrequency (RF) ablation duration (Model 2: OR, 1.02 [95% CI, 1.01–1.03], p = 0.003). Although the incidence of post-AFCA stiff LA physiology was 3.7% and most of the cases were subclinical, the empirical extra-PV ablation was associated with this undesirable condition. In addition, patients who had low mean LA voltage before AFCA could be susceptible to stiff LA physiology.

Utilisation of Robotic Navigation Systems in the Treatment of Atrial Fibrillation

2010 ◽  
Vol 6 (3) ◽  
pp. 60
Author(s):  
Richard Schilling ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Navigation System ◽  
Antiarrhythmic Drugs ◽  
Rhythm Control ◽  
Navigation Systems ◽  
Robotic Navigation ◽  
Increased Risk ◽  
Common Strategy ◽  
Catheter Navigation

Atrial fibrillation (AF) is linked to an increased risk of adverse cardiovascular events. While rhythm control with antiarrhythmic drugs (AADs) is a common strategy for managing patients with AF, catheter ablation may be a more efficacious and safer alternative to AADs for sinus rhythm control. Conventional catheter ablation has been associated with challenges during the arrhythmia mapping and ablation stages; however, the introduction of two remote catheter navigation systems (a robotic and a magnetic navigation system) may potentially overcome these challenges. Initial clinical experience with the robotic navigation system suggests that it offers similar procedural times, efficacy and safety to conventional manual ablation. Furthermore, it has been associated with reduced fluoroscopy exposure to the patient and the operator as well as a shorter fluoroscopy time compared with conventional catheter ablation. In the future, the remote navigation systems may become routinely used for complex catheter ablation procedures.

Sign in / Sign up

Export Citation Format

Share Document