Key Issues in the Management of Atrial Fibrillation - Protecting the Patient and Controlling the Arrhythmia

2007 ◽  
Vol 52 (3) ◽  
pp. 27-35 ◽  
Author(s):  
S M M Jenkins ◽  
F G Dunn
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Risk ◽  
Control Strategies ◽  
Management Strategies ◽  
Heart Association ◽  
Clinical Excellence ◽  
Evidence Base ◽  
Surgical Interventions ◽  
Key Issues ◽  
European Society Of Cardiology

Atrial fibrillation (AF) is the most common sustained tachyarrhythmia and its prevalence is increasing. It is an independent risk factor for stroke and is associated with significant morbidity and mortality. AF currently accounts for 1% of NHS expenditure. The management of AF has a broad evidence base and both the American College of Cardiology/American Heart Association/European Society of Cardiology (ACC/AHA/ESC) and the National Institute for Clinical Excellence (NICE) have recently published guidelines. Some controversy persists regarding stroke risk stratification and appropriate anticoagulation regimes although a general consensus is now emerging. Rate and rhythm control strategies have been shown to be comparable in terms of clinical outcomes. Current anti-arrhythmic drugs have limited efficacy and significant side-effect profiles. Electrophysiological and surgical interventions have a role in both strategies. This article broadly reviews the evidence for different management strategies in AF and presents a practical approach to treatment in light of the recently published national and international guidelines.

scholarly journals Same rhythm, different song—approaches to atrial fibrillation management by cardiologists and nephrologists

2020 ◽  
Author(s):  
Patrick B Mark ◽  
Lucia Del Vecchio ◽  
Jose M Valdivielso ◽  
Jolanta Malyszko
Keyword(s):  
Atrial Fibrillation ◽  
Control Strategies ◽  
Management Strategies ◽  
Heart Rhythm ◽  
Evidence Base ◽  
Thromboembolic Complication ◽  
Healthcare Burden ◽  
Randomized Controlled ◽  
Improved Outcomes ◽  
Increased Risk

Abstract Atrial fibrillation (AF) is common in patients with chronic kidney disease (CKD), affecting 10–25% of patients requiring dialysis. Compared with the general population, patients requiring dialysis are also at increased risk of stroke, the major thromboembolic complication of AF. The evidence base for management strategies of AF specific to patients with advanced CKD is limited and not informed by randomized controlled trials. These gaps in evidence encompass rate and rhythm control strategies as well as a paucity of data informing which patients should receive anticoagulation. The European Renal Association–European Dialysis and Transplant Association and European Heart Rhythm Association undertook a survey of nephrologists and cardiologists exploring management strategies in patients with AF and CKD. We review the results of this survey, highlighting the differences in clinical approaches from cardiologists and nephrologists to these conditions. Closer collaboration between these specialties should lead to improved outcomes for patients with advanced CKD and AF. Specific issues that will need to be addressed may include healthcare burden to patients, location of clinics compared with dialysis sites and awareness of complications of treatments specific to CKD, such as calciphylaxis associated with vitamin K antagonism.

scholarly journals Women and Atrial Fibrillation

2020 ◽  
Author(s):  
ANNABELLE VOLGMAN ◽  
Emelia Benjamin ◽  
Anne Curtis ◽  
Margaret Fang ◽  
Kathryn Lindley ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Control Strategies ◽  
Management Strategies ◽  
Treatment Strategies ◽  
The United States ◽  
Evidence Base ◽  
Rhythm Control ◽  
Control Treatment ◽  
Increased Risk ◽  
Control Management

Atrial fibrillation (AF) remains a growing problem in the United States and worldwide, imposing a high individual and health system burden, including increased resource consumption due to repeated hospitalizations, stroke, dementia, heart failure, and death. This comprehensive review summarizes the most recent data on sex-related differences in risks associated with AF. Women with AF have increased risk of stroke and death compared to men, and possible reasons for this disparity are explored. Women also continue to have worse symptoms and quality of life, and poorer outcomes with stroke prevention, as well as with rate and rhythm control management strategies. Many current rhythm control treatment strategies for AF, including cardioversion and ablation, are used less frequently in women as compared to men, whereas women are more likely to be treated with rate control strategies or anti-arrhythmic drugs. Sex differences should be considered in treating women with AF to improve outcomes and women and men should be offered the same interventions for AF. We need to improve the evidence base to understand if variation in utilization of rate and rhythm control management between men and women represents health inequities or appropriate clinical judgement.

scholarly journals Atrial fibrillation: review of the European Society of Cardiology guidelines and national guidelines 2020

2020 ◽  
pp. 21-29
Author(s):  
Natalia S. Mescherina ◽  
Elena M. Khardikova ◽  
Igor A. Saraev
Keyword(s):  
Atrial Fibrillation ◽  
European Society ◽  
Stroke Risk ◽  
Diagnosis And Treatment ◽  
Russian Society ◽  
Thromboembolic Complications ◽  
National Guidelines ◽  
European Society Of Cardiology ◽  
Risk Symptom

The review presents the key provisions of the recommendations of the Russian society of cardiology and the guidelines of the European society of cardiology for the diagnosis and treatment of atrial fibrillation (AF), updated in 2020. The recommendations clearly state the requirements for atrial fibrillation diagnosis verification, and propose an approach to the formation of a complex characteristic of the disease in four positions, which is designated as 4S-AF (Stroke risk, Symptom severity, Severity of AF burden, Substrate severity). The authors analyzed the strategy "CC To ABC" (Confirm AF, Characterize AF, Treat AF: the ABC pathway) proposed by European experts, the issues of modern terminology and requirements for verifying the diagnosis of AF, complex characteristics of the disease and stratification of the risk of stroke and bleeding, a new ABC approach in the treatment of AF, where A is anticoagulant prevention of thromboembolic complications, B is the control of symptoms of the disease and C is the detection and treatment of comorbid pathology. The General principles that have changed in comparison with the previous versions of guidelines of 2016 on the initiation and tactics of anticoagulant therapy, pharmacological and non-drug cardioversion, catheter ablation in patients with AF, affecting the prognosis and outcomes in patients with AF, are outlined. It is emphasized that the pattern of atrial fibrillation (first diagnosed, paroxysmal, persistent, long-term persistent, permanent) should not determine the indications for anticoagulant prevention. The solution to this issue is determined by the level of risk according to the CHA2DS2-VASc scale. The introduction of the considered methods of diagnosis and treatment of AF into clinical practice will optimize the burden on the health care system and reduce the costs associated with the burden of AF.

scholarly journals Subclinical and Device-Detected Atrial Fibrillation: Pondering the Knowledge Gap: A Scientific Statement From the American Heart Association

Circulation ◽  
2019 ◽  
Vol 140 (25) ◽  
Author(s):  
Peter A. Noseworthy ◽  
Elizabeth S. Kaufman ◽  
Lin Y. Chen ◽  
Mina K. Chung ◽  
Mitchell S.V. Elkind ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Risk ◽  
American Heart ◽  
Electronic Devices ◽  
Heart Association ◽  
Cardiac Implantable Electronic Devices ◽  
Increased Risk ◽  
Scientific Statement ◽  
Existing Data

The widespread use of cardiac implantable electronic devices and wearable monitors has led to the detection of subclinical atrial fibrillation in a substantial proportion of patients. There is evidence that these asymptomatic arrhythmias are associated with increased risk of stroke. Thus, detection of subclinical atrial fibrillation may offer an opportunity to reduce stroke risk by initiating anticoagulation. However, it is unknown whether long-term anticoagulation is warranted and in what populations. This scientific statement explores the existing data on the prevalence, clinical significance, and management of subclinical atrial fibrillation and identifies current gaps in knowledge and areas of controversy and consensus.

scholarly journals Patterns of Care for Atrial Fibrillation Before, During, and at Discharge From Hospitalization

2021 ◽  
Vol 14 (4) ◽  
Author(s):  
Nihar R. Desai ◽  
Christopher T. Sciria ◽  
Xin Zhao ◽  
Jonathan P. Piccini ◽  
Mintu P. Turakhia ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Control Strategies ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Heart Association ◽  
Rhythm Control ◽  
Hospitalized Patients ◽  
Af Ablation ◽  
Occlusion Device ◽  
Younger Age

Background: Atrial fibrillation (AF) is the most common arrhythmia encountered in the hospital. However, contemporary treatment of patients hospitalized with AF, including stroke prevention, switching between these therapies, and rhythm control interventions are not well studied. We aimed to examine trends in inpatient interventions for AF, including switching oral anticoagulation (warfarin to direct oral anticoagulants [DOACs]), cardioversion, catheter ablation, and amiodarone use in hospitalized patients with AF. Methods: Using data from the Get With The Guidelines—AFIB registry from the American Heart Association, we analyzed patterns of medication and procedure use among hospitalized patients with AF from January 3, 2013, to March 28, 2017. To identify significant predictors of switching, multivariable hierarchical regression models were developed with patient baseline characteristics and comorbidities. Results: Among 31 280 patients with AF from 97 participating hospitals, 47.1% were on anticoagulation at presentation (6695 warfarin and 7393 DOAC) and the majority were continued at discharge (91.1%). Of those who were not receiving anticoagulation before hospitalization, 60.6% started anticoagulation at discharge (25.0% warfarin and 75.0% DOAC). The prevalence of switching from warfarin to DOAC was 4.0% and was more likely with younger age and lower CHA 2 DS 2 -VASc. Among 28 143 patients (excluding those discharged from the emergency department or observation status), 32.0% underwent cardioversion (56.1% chemically assisted and 49.4% electrical), 6.4% AF ablation, and 1.0% left atrial appendage occlusion device implantation. Patients of White race, younger age, and lower CHA 2 DS 2 -VASc were significantly more likely to undergo cardioversion or AF ablation, while older patients with higher CHA 2 DS 2 -VASc were significantly more likely to be initiated on amiodarone. Conclusions: Despite guideline recommendations prioritizing DOAC therapy, there are relatively low rates of switching from warfarin to DOAC in patients hospitalized with AF. Moreover, there is substantial variation in switching and utilization of rhythm control strategies, highlighting opportunities for performance improvement. Graphic Abstract: A graphic abstract is available for this article.

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