Atrial Fibrillation

2016 ◽  
Author(s):  
Tareq Al-Salamah ◽  
Laura J. Bontempo
Keyword(s):  
Atrial Fibrillation ◽  
Rate Control ◽  
Oral Anticoagulation ◽  
Scoring System ◽  
Treatment Guidelines ◽  
Anticoagulation Therapy ◽  
Heart Association ◽  
Heart Rhythm ◽  
Heart Beat ◽  
Nonvalvular Atrial Fibrillation

Atrial fibrillation (AF) is a supraventricular tachyarrhythmia characterized by chaotic atrial electrical activity.  It is associated with heart failure, stroke, and reduced quality of life. AF is frequently recurrent and refractory to treatment. These facts underscore the importance of recognizing this arrhythmia even in its asymptomatic form. This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of AF. Figures show AF, atrial flutter, and AF with preexcitation on a 12-lead electrocardiogram, rate control agent selection recommendations, and a decision-making algorithm for oral anticoagulation therapy. Tables list etiologies and risk factors for AF, American Heart Association/American College of Cardiology/Heart Rhythm Society classification of AF, some of the clinical consequences of AF, diagnostic evaluation for AF, antiarrhythmic drugs for conversion of AF, drugs used for acute rate control of AF, CHA2DS2-VASc score calculation, CHA2DS2-VASc  adjusted stroke rate and treatment guidelines, scoring system to assess the risk of bleeding with oral anticoagulation: HAS-BLED (hypertension, abnormal renal/liver function, history of stroke, bleeding history or predisposition, labile international normalized ratio, elderly [65 years], drugs/alcohol concomitant), and HAS-BLED scores with proportion of patients from the Euro Heart Survey in each category and associated major bleeding risk.   This review contains 5 highly rendered figures, 10 tables, and 69 references Key words: Atrial fibrillation; Supraventricular tachycardia; Irregular heart beat; Cardioversion; Nonvalvular atrial fibrillation; Paroxysmal atrial fibrillation; Rate control; CHA2DS2-VASc scoring system; Rhythm control

scholarly journals Outpatient Management of Oral Anticoagulation Therapy in Patients with Nonvalvular Atrial Fibrillation

2009 ◽  
Vol 9 (4) ◽  
pp. 313-319 ◽  
Author(s):  
Aida Kulo ◽  
Nedžad Mulabegović ◽  
Jasna Kusturica ◽  
Hasija Hadžić ◽  
Lejla Burnazović-Ristić ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulation ◽  
Anticoagulation Therapy ◽  
Dose Titration ◽  
Nonvalvular Atrial Fibrillation ◽  
Annual Dose ◽  
Oral Anticoagulation Therapy ◽  
Anticoagulation Treatment ◽  
One Year

Due to heightened risk for thromboembolic complications, nonvalvular atrial fibrillation (NVAF) presents an absolute indication for long-term oral anticoagulation therapy. This was an observational, analytical, randomised, one-year clinical study, conducted in the Blood Transfusion Institute Sarajevo, Bosnia & Herzegovina. The aim of this study was to present the oral anticoagulation treatment in terms of International normalised ratio (INR) monitoring and warfarin/acenocoumarol dose titration in 117 patients with NVAF. INR values, the doses of warfarin and acenocoumarol, as well as the tendency and adequacy of their changes were monitored. Percentages of the therapeutic INR values were 51,77% and 53,62%, subtherapeutic 42,84% and 35,86%, and supratherapeutic 5,39% and 10,53% for the warfarin and acenocoumarol treatment, respectively. The average total weekly doses (TWD) which most frequently achieved the therapeutic INR values were 27,89±12,34 mg and 20,44±9,94 mg, for warfarin and aceno- coumarol, respectively. The dose changes with the INR values 1,7 or lower/3,3 or higher were omitted in 13,46% and 15,63%, and with the INR values 1,8-3,2 were noted in 8,62% and 13,48% of all the check-up visits in the warfarin and acenocoumarol group, respectively. The annual dose changes were noted in 24,65% and 31,41%, and the daily dose changes in 74,43% and 73,36% of all the check-up visits of warfarin and acenocoumarol group, respectively. We can conclude that the management of the oral anticoagulation treatment in our country is in accordance with the relevant recommendations, but with the present tendency toward underdosing and unnecessary frequent dose changing.

Atrial Fibrillation

2011 ◽  
Author(s):  
Gregory F. Michaud ◽  
Roy M. John
Keyword(s):  
Atrial Fibrillation ◽  
Rate Control ◽  
Oral Anticoagulation ◽  
Thrombus Formation ◽  
Control Strategies ◽  
Anticoagulation Therapy ◽  
Scoring Systems ◽  
Right Atrial ◽  
Medical Attention ◽  
Clinical Consequences

Atrial fibrillation (AF) is an abnormal rhythm characterized by chaotic atrial electrical activity resulting in loss of atrial contraction, an irregular and unpredictable heart rate, and a tendency for thrombus formation. The prevalence of AF is estimated at 1 to 2%, but it’s likely higher than that because one-third of patients may have no symptoms and might never seek medical attention. Data suggest that 1 in 4 people over the age of 40 will develop AF in their lifetime. About 10% of patients over age 80 have experienced the arrhythmia, and some estimates predict the prevalence will double in the next 50 years. This chapter discusses the pathophysiology, genetics, diagnosis, classification, and treatment of AF. Figures show atrial fibrillation and coarse atrial fibrillation plus common right atrial flutter. One algorithm is for oral anticoagulation therapy, and a second shows a recommended hierarchical choice of antiarrhythmic therapies versus catheter ablation for recurrent symptomatic atrial fibrillation. Tables list classification, diagnostic evaluation of, clinical consequences of, and conditions often associated with atrial fibrillation. Three scoring systems are included: 1) for congestive heart failure, hypertension, diabetes, stroke, and transient ischemic attack; 2) to assess the risk of bleeding with oral anticoagulation, and 3) data and proportion of patients from the Euro Heart Survey. Other tables include long-term anticoagulation guidelines for atrial fibrillation, intravenous drugs used for acute rate control, oral drugs used for chronic rate control, and antiarrhythmic drugs for conversion of atrial fibrillation and/or maintenance of sinus rhythm. In addition, there’s a summary of randomized trials weighing rate control and rhythm control strategies, plus schemes for categorizing thromboembolism risk. This review contains 4 highly rendered figures, 13 tables, and 129 references.

Abstract 19336: Reported Stroke Rates in Patients With Nonvalvular Atrial Fibrillation in North America are Lower Than Those Cited in ESC and AHA Guidelines

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Gene R Quinn ◽  
Daniel E Singer
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Heart Association ◽  
Heart Rhythm ◽  
Bleeding Risk ◽  
Net Benefit ◽  
Nonvalvular Atrial Fibrillation ◽  
Score Threshold ◽  
Esc Guidelines ◽  
European Society Of Cardiology

Background: Anticoagulants (OAC) decrease ischemic stroke rates in patients with atrial fibrillation (AF) but increase the risk of bleeding. The risk of ischemic stroke where the absolute benefit of anticoagulation outweighs the bleeding risk has been shown to be 1-2% per year. The American Heart Association/American College of Cardiology/Heart Rhythm Society and the European Society of Cardiology (ESC) guidelines have adopted the CHA2DS2-VASc stroke risk score; their recommendations assume the scheme’s point scores correspond to fixed stroke rates. However, reported rates of stroke vary widely across cohorts, placing in question the generalizability of guideline recommendations. Objective: To contrast the reported rates of stroke in North American (NA) patients with AF who do not take OAC with the Danish AF cohort used to create the ESC guidelines. Methods: We conducted a systematic review to identify all cohort studies and randomized controlled trials including patients with non-valvular AF not treated with OAC. We excluded studies that enrolled only patients undergoing surgical procedures or cardioversion, or only patients with specific comorbidities such as prior stroke or kidney disease. Results: Of the 3,552 studies screened, we identified 13 eligible NA studies representing 137,652 patients. Larger and more contemporary cohorts generally had lower stroke rates (Table). When weighted by number of subjects, the NA cohorts’ ischemic stroke rate averaged 1.88% per year, whereas the Danish cohort had a rate of 4.66% per year. Conclusions: Large variation exists in stroke rates across putatively representative cohorts. This may reflect true differences in rates or methodologic differences among studies. These differences could change the point score threshold for recommending OAC in lower risk regions. Reexamining the net benefit of OAC in patients with a CHA2DS2-VASc score of 1 or 2 seems warranted, particularly for those with weak 1-point risk factors.

Atrial Fibrillation

2020 ◽  
Author(s):  
Gregory F. Michaud ◽  
Roy M. John
Keyword(s):  
Atrial Fibrillation ◽  
Rate Control ◽  
Oral Anticoagulation ◽  
Thrombus Formation ◽  
Control Strategies ◽  
Anticoagulation Therapy ◽  
Scoring Systems ◽  
Right Atrial ◽  
Medical Attention ◽  
Clinical Consequences

Atrial fibrillation (AF) is an abnormal rhythm characterized by chaotic atrial electrical activity resulting in loss of atrial contraction, an irregular and unpredictable heart rate, and a tendency for thrombus formation. The prevalence of AF is estimated at 1 to 2%, but it’s likely higher than that because one-third of patients may have no symptoms and might never seek medical attention. Data suggest that 1 in 4 people over the age of 40 will develop AF in their lifetime. About 10% of patients over age 80 have experienced the arrhythmia, and some estimates predict the prevalence will double in the next 50 years. This chapter discusses the pathophysiology, genetics, diagnosis, classification, and treatment of AF. Figures show atrial fibrillation and coarse atrial fibrillation plus common right atrial flutter. One algorithm is for oral anticoagulation therapy, and a second shows a recommended hierarchical choice of antiarrhythmic therapies versus catheter ablation for recurrent symptomatic atrial fibrillation. Tables list classification, diagnostic evaluation of, clinical consequences of, and conditions often associated with atrial fibrillation. Three scoring systems are included: 1) for congestive heart failure, hypertension, diabetes, stroke, and transient ischemic attack; 2) to assess the risk of bleeding with oral anticoagulation, and 3) data and proportion of patients from the Euro Heart Survey. Other tables include long-term anticoagulation guidelines for atrial fibrillation, intravenous drugs used for acute rate control, oral drugs used for chronic rate control, and antiarrhythmic drugs for conversion of atrial fibrillation and/or maintenance of sinus rhythm. In addition, there’s a summary of randomized trials weighing rate control and rhythm control strategies, plus schemes for categorizing thromboembolism risk. This chapter contains 129 references

Atrial Fibrillation

2020 ◽  
Author(s):  
Gregory F. Michaud ◽  
Roy M. John
Keyword(s):  
Atrial Fibrillation ◽  
Rate Control ◽  
Oral Anticoagulation ◽  
Thrombus Formation ◽  
Control Strategies ◽  
Anticoagulation Therapy ◽  
Scoring Systems ◽  
Right Atrial ◽  
Medical Attention ◽  
Clinical Consequences

Atrial fibrillation (AF) is an abnormal rhythm characterized by chaotic atrial electrical activity resulting in loss of atrial contraction, an irregular and unpredictable heart rate, and a tendency for thrombus formation. The prevalence of AF is estimated at 1 to 2%, but it’s likely higher than that because one-third of patients may have no symptoms and might never seek medical attention. Data suggest that 1 in 4 people over the age of 40 will develop AF in their lifetime. About 10% of patients over age 80 have experienced the arrhythmia, and some estimates predict the prevalence will double in the next 50 years. This chapter discusses the pathophysiology, genetics, diagnosis, classification, and treatment of AF. Figures show atrial fibrillation and coarse atrial fibrillation plus common right atrial flutter. One algorithm is for oral anticoagulation therapy, and a second shows a recommended hierarchical choice of antiarrhythmic therapies versus catheter ablation for recurrent symptomatic atrial fibrillation. Tables list classification, diagnostic evaluation of, clinical consequences of, and conditions often associated with atrial fibrillation. Three scoring systems are included: 1) for congestive heart failure, hypertension, diabetes, stroke, and transient ischemic attack; 2) to assess the risk of bleeding with oral anticoagulation, and 3) data and proportion of patients from the Euro Heart Survey. Other tables include long-term anticoagulation guidelines for atrial fibrillation, intravenous drugs used for acute rate control, oral drugs used for chronic rate control, and antiarrhythmic drugs for conversion of atrial fibrillation and/or maintenance of sinus rhythm. In addition, there’s a summary of randomized trials weighing rate control and rhythm control strategies, plus schemes for categorizing thromboembolism risk. This review contains 4 highly rendered figures, 14 tables, and 129 references.

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