Atrial Fibrillation
- Diagnosis, Imaging, Screening
- General Information
- Guidelines
- Internet Sites
- Risk Factors
- Risk Reduction
- Treatment
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Atrial Fibrillation
NIH - What Is Atrial Fibrillation? “Atrial fibrillation (A-tre-al fi-bri-LA-shun), or AF, is the most common arrhythmia (ah-RITH-me-ah). An arrhythmia is a problem with the speed or rhythm of the heartbeat. A disorder in the heart’s electrical system causes AF and other types of arrhythmia. AF occurs when rapid, disorganized electrical signals in the heart’s two upper chambers, called the atria (AY-tree-uh), cause them to contract very fast and irregularly (this is called fibrillation). As a result, blood pools in the atria and isn’t pumped completely into the heart’s two lower chambers, called the ventricles (VEN-trih-kuls). When this happens, the heart’s upper and lower chambers don’t work together as they should. Often, people who have AF may not even feel symptoms. However, even when not noticed, AF can lead to an increased risk of stroke. In many patients, particularly when the rhythm is extremely rapid, AF can cause chest pain, heart attack, or heart failure. AF may occur rarely or every now and then, or it may become a persistent or permanent heart rhythm lasting for years. “
NIH - Medical Enyclopedia: Atrial fibrillation/flutter "Atrial fibrillation/flutter is a heart rhythm disorder (arrhythmia). It usually involves a rapid heart rate, in which the upper heart chambers (atria) are stimulated to contract in a very disorganized and abnormal manner."
NHS – Atrial Fibrillation “Because of the way the heart is beating in atrial fibrillation, the blood in the atria (upper chambers of the heart) does not flow in a normal manner and is very turbulent. This can result in blood clots forming. These clots may then be swept into the ventricles (lower chambers of the heart) and pumped into the lungs or into the general circulation. Clots in the general circulation can block arteries in the brain, causing a stroke. The risk of stroke in patients with atrial fibrillation is about double that in the general population. The overall incidence of stroke in these people is 5 % per year. This risk is increased with age, high blood pressure, heart failure, diabetes and a history of embolism (blood clots).”
Highlighted Articles
Focus On Atrial Fibrillation Recognizes Growing Importance Of Common Arrhythmia (2008) "Atrial fibrillation occurs when the upper chambers of the heart--the atria--quiver in an uncoordinated way rather than contracting with a steady tempo. Not only can this result in a rapid, irregular heart beat, but blood can pool in the atria and form clots that travel to the brain, causing a stroke. Some 3 percent to 4 percent of people over age 60 have atrial fibrillation, a risk that climbs to more than 5 percent after age 70."
Atrial fibrillation. (Mt Sinai J Med. 2006) "Diabetes, hypertension, congestive heart failure, valvular disease, and myocardial infarction are all risk factors in the development of atrial fibrillation. And the diagnosis confers a five-fold increase in the incidence of stroke."
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Notes
The Guidelines section will contain 2008 and some 2007 updated published guidelines. To view Guidelines from previous years, view the Guideline sections or the Article sections or our Monthly Online Newsletter (under the Guidelines section).
Atrial Fibrillation
Daily Treatment Report
Cognitive Therapy-CBT-Psychotherapy
Device Therapy
2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities
The role of pacemakers in the management of patients with atrial fibrillation. (Med Clin North Am. 2008) "Pacemakers have an important role in the major strategies for the management of atrial fibrillation, rate control and rhythm control. Of all the current non-pharmacologic therapies for atrial fibrillation, the use of pacemakers impacts the largest number of patients."
Drug Side-Effects and Interactions
Amiodarone-induced thyrotoxicosis. A review. (Minerva Endocrinol. 2008) “Amiodarone (AM), a potent class III anti-arrhythmic drug, is an iodine-rich compound with a structural resemblance to thyroid hormones triiodothyronine (T3) and thyroxine (T4). At the commonly employed doses, AM causes iodine overlaod up to 50-100 times the optimal daily intake, which may be responsible of a spectrum of effects on thyroid function often counterbalancing its heart benefits. Although most patients on chronic AM treatment remain euthyroid, a consistent proportion may develop thyrotoxicosis (AM-induced thyrotoxicosis, AIT) or hypothyroidism.”
Ataxia caused by amiodarone in older people. (Age Ageing. 2008)
Safety considerations in the pharmacological management of atrial fibrillation. (Int J Cardiol. 2008)
Drugs
Continuous vs Episodic Prophylactic Treatment With Amiodarone for the Prevention of Atrial Fibrillation (JAMA. 2008) “Conclusions In this study population, there was no difference in the composite of amiodarone and cardiac major adverse events between groups. However, patients receiving episodic treatment had a significantly increased rate of atrial fibrillation recurrence and a significantly higher rate of all-cause mortality and cardiovascular hospitalizations.”
The quality of anticoagulation on functional outcome and mortality for TIA/stroke in atrial fibrillation patients. (Int J Cardiol. 2008)
Anticoagulation: stroke prevention in patients with atrial fibrillation. (Med Clin North Am. 2008) "It is well recognized that during atrial fibrillation (AF), clots may form in the left atrium. This, in turn, may lead to embolization of the clot, with resulting ischemic stroke or systemic embolism. Also, the presence of AF confers a fivefold increased risk for stroke. AF is the most common and important cause of stroke resulting from any cause."
Exercise
Moderate physical exercise: a simplified approach for ventricular rate control in older patients with atrial fibrillation. (Clin Res Cardiol. 2008) “CONCLUSION: Regular moderate physical activity decreases VR at rest and during exercise while increasing exercise capacity. Physical training should be taken into account for ventricular rate control during AF.”
General Information
Treatment of atrial fibrillation. (Br Med Bull. 2008)
Ablation of atrial fibrillation : Patient selection, techniques, and the results. (Herzschrittmacherther Elektrophysiol. 2008)
AF-CHF: Even in Heart Failure, Rate-Control Strategy Best for Atrial Fibrillation
Atrial and ventricular fibrosis induced by atrial fibrillation: Evidence to support early rhythm control. (Heart Rhythm. 2008)
A Patient's Guide to Living With Atrial Fibrillation
Management of atrial fibrillation in patients with heart failure. (J Card Fail. 2008)
Novel non-pharmacological approaches for antiarrhythmic therapy of atrial fibrillation (Europace 2008)
Statins and polyunsaturated fatty acids for treatment of atrial fibrillation. (Nat Clin Pract Cardiovasc Med. 2008) "Despite advances in pharmacological and nonpharmacological therapies for rhythm or rate control in patients with AF, primary prevention with 'upstream' therapy and risk factor modification is likely to produce a far greater effect in the general population than specific interventions. Rapidly developing experimental work has provided new insights into AF pathophysiology that will lead to new mechanism-based therapies. Agents targeting inflammation, oxidative injury, atrial myocyte metabolism, extracellular matrix remodeling, and fibrosis, have theoretical advantages as novel therapeutic strategies. Angiotensin-converting-enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, statins, and omega-3 polyunsaturated fatty acids have shown antiarrhythmic potential, over and above any effect related to the treatment of underlying heart disease."
Guidelines
Immunotherapy
Internet Sites
Treatment Information
Drug-Food-Supplement Information
DrugDigest (drug interactions)
FDA - Drug Interactions: What You Should Know
NIH - Botanical Dietary Supplements: Background Information
NIH - Drug, Supplements, and Herbal Information
NIH - Herbal Supplements: Consider Safety, Too
NIH - Vitamin and Mineral Supplement Fact Sheets
Nutrition
Other
Other Treatments
Nonablative minimally invasive thermal therapies in the treatment of symptomatic benign prostatic hyperplasia. (Curr Opin Urol. 2008)
Experimental
Radiotherapy
Supplements-Vitamins-CAM
Effect of fish oil on arrhythmias and mortality: systematic review (BMJ 2008)
Effects of garlic on the induction of ventricular fibrillation. (Nutrition. 2008) "CONCLUSION: Garlic cannot alter the VFT, but it significantly decreases the ULV in a dose-dependent pattern, indicating that it can reduce the range of the stimulation strength between the VFT and ULV (vulnerability window) during the vulnerable period of a cardiac cycle."
Surgery
Complications of Catheter Ablation for Atrial Fibrillation: Incidence and Predictors. (J Cardiovasc Electrophysiol. 2008)
Frequency of recurrence of atrial fibrillation within 48 hours after ablation and its impact on long-term outcome. (Am J Cardiol. 2008) "In conclusion, early recurrence of AF within 48 hours after ablation was a significant predictor of a poor long-term ablation outcome. However, because nearly half the patients with early recurrence of AF remained AF free during long-term follow-up, early recurrence of AF should not automatically result in an early repeated procedure."
Minimally invasive surgical ablation of atrial fibrillation: The thoracoscopic box lesion approach. (J Interv Card Electrophysiol. 2008)
Surgical ablation devices for atrial fibrillation. (J Interv Card Electrophysiol. 2008) "The goal of these devices is to create conduction block to either block activation wavefronts or to isolate the triggers of AF."
Current Status of the Surgical Treatment of Atrial Fibrillation. (World J Surg. 2007) "Atrial fibrillation (AF) affects several million patients worldwide and is associated with a number of heart conditions, particularly coronary artery disease, rheumatic heart disease, hypertension, and congestive heart failure. The treatment of AF and its complications is quite costly. . Pharmacological therapy is at best 50% effective. Therapeutic options for AF include antiarrhythmic drugs, cardioversion, atrioventricular (A-V) node block, pacemaker insertion, and ablative surgery. In 1987, Cox developed an effective surgical procedure to achieve ablation. Current ablative procedures include the classic cut-and-sew Maze operation or a modification of it, namely through catheter ablation, namely, cryoablation, radiofrequency ablation (dry or irrigated), and other forms of ablation (e.g., laser, microwave)."
Transplantation
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