Atrial Fibrillation
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- Internet Sites
- Risk Factors
- Risk Reduction
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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
View Treatment Guidelines from previous years. Go to Treatment for each year.
Atrial Fibrillation
Daily Treatment Report
Cognitive Therapy-CBT-Psychotherapy
Device Therapy
Effectiveness of Implantable Cardioverter-Defibrillators for the Primary Prevention of Sudden Cardiac Death in Women With Advanced Heart Failure (Arch Intern Med. 2009) “Conclusions Implantable cardioverter-defibrillator therapy for the primary prevention of sudden cardiac death in women does not reduce all-cause mortality. Further studies are needed to investigate the reasons for this ob servation and to define the population of women who may benefit most from implantable cardioverter-defibrillator therapy.”
Drug Side-Effects and Interactions
Drugs
Amiodarone - A 'Broad Spectrum' Antiarrhythmic Drug. (Cardiovasc Hematol Disord Drug Targets. 2009) “Amiodarone, an iodinated benzofuran derivative, introduced in 1960's as an anti-anginal agent, emerged as a potent anti-arrhythmic agent by 1970's and is currently one of the most commonly prescribed drugs in US for ventricular and atrial arrhythmias. Although amiodarone is considered a class III anti-arrhythmic agent, it also has class I, II, IV actions, making it a unique and effective anti-arrhythmic agent. Because of its minimal negative inotropic activity and very low rate of pro-arrhythmia, it is considered safe in treating arrhythmias in patients with Coronary Artery Disease and Left ventricular systolic dysfunction. Despite these advantages, long term oral therapy with amiodarone is limited by side effect profile involving various organs like thyroid, lung, heart, liver, skin etc. Though the side effects can be decreased significantly by keeping the maintenance dose at 200 to 300 mg/day, patients on amiodarone should be followed closely. Amiodarone interacts with medications such as Warfarin, Digoxin, Macrolides, Floroquinolones etc., which share Cytochrome P450 metabolic pathway. Hence reducing their doses prior to starting amiodarone is recommended. Amiodarone, a category D drug, is contraindicated in pregnant and breast feeding women.”
Cardioversion of Atrial Fibrillation and the use of antiarrhythmic drugs. (Heart. 2009)
Dabigatran versus Warfarin in Patients with Atrial Fibrillation. (N Engl J Med. 2009)
The Net Clinical Benefit of Warfarin Anticoagulation in Atrial Fibrillation (Annals 2009)
Dronedarone for atrial fibrillation: a new therapeutic agent (Vasc Health Risk Manag. 2009) “Amiodarone is currently one of the most widely used and most effective antiarrhythmic agents for atrial fibrillation. But during chronic usage amiodarone can cause some serious extra cardiac adverse effects, including effects on the thyroid. Dronedarone is a newer therapeutic agent with a structural resemblance to amiodarone, with two molecular changes, and with a better side effect profile. Dronedarone is a multichannel blocker and, like amiodarone, possesses both a rhythm and a rate control property in atrial fibrillation.”
Dronedarone. (Circulation. 2009)
Effect of Clopidogrel Added to Aspirin in Patients with Atrial Fibrillation.The ACTIVE Investigators. (N Engl J Med. 2009) “CONCLUSIONS: In patients with atrial fibrillation for whom vitamin K-antagonist therapy was unsuitable, the addition of clopidogrel to aspirin reduced the risk of major vascular events, especially stroke, and increased the risk of major hemorrhage.”
Antithrombotic therapy for the treatment of atrial fibrillation in the elderly. ( J Interv Card Electrophysiol. 2009)
Exercise
General Information
Prevention of Atrial Fibrillation-Related Stroke
Treatment of Atrial Fibrillation With Antiarrhythmic Drugs or Radiofrequency Ablation (Circ Arrhythmia Electrophysiol 2009)
Management of atrial fibrillation in the elderly. (Minerva Med. 2009)
Effect of Age on Stroke Prevention Therapy in Patients With Atrial Fibrillation. The Atrial Fibrillation Investigators. (Stroke. 2009)
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
Experimental
Radiotherapy
Supplements-Vitamins-CAM
Independent inverse relationship between serum lycopene concentration and arterial stiffness. (Atherosclerosis. 2009)
Surgery
Radiofrequency Ablation for Atrial Fibrillation: A Guide for Adults
Antiarrhythmics After Ablation of Atrial Fibrillation (5A Study) (Circulation. 2009)
Ablation of atrial fibrillation: What can we tell our patients? “Key points During the procedure, scar tissue is created in rings around the ostia of the pulmonary veins and in other locations in the left atrium to electrically isolate triggers of fibrillation and areas that maintain it. Results of the procedure are superior to those of drug therapy. Success rates are higher for those with paroxysmal atrial fibrillation than for those with persistent atrial fibrillation. The main indication for this procedure is failure of drug therapy or inability to tolerate drug therapy. Patients must understand that ablation therapy will not eliminate the need to take anticoagulant drugs. More patients with atrial fibrillation are asking their physicians about catheter-based radiofrequency ablation as a treatment option. Indeed, in the mere 10 years or so since this procedure was introduced, it has shown promising clinical results. Still, it is not yet available at many medical centers, and it is not yet considered the first-line treatment for atrial fibrillation.1 Moreover, some patients may have unrealistic expectations about it, such as being able to stop taking anticoagulant drugs afterward. It is therefore important for health care professionals not only to recognize which patients may benefit from catheter-based treatment, but also to educate them about it so they have reasonable expectations. “
Systematic Review: Comparative Effectiveness of Radiofrequency Catheter Ablation for Atrial Fibrillation. (Ann Intern Med. 2009)
Mortality after catheter ablation for atrial fibrillation compared with antiarrhythmic drug therapy. A meta-analysis of randomized trials. (Am Heart J. 2009)
Complications of Atrial Fibrillation Ablation in a High-Volume Center in 1,000 Procedures: Still Cause for Concern? (Journal of Cardiovascular Electrophysiology 2009) “Conclusion: AF ablation still has a considerable number of major complications that may be life threatening or may lead to severe residues. Atrial-esophageal fistula is still observed despite continuous systematic methods to prevent it. Stroke, tamponade, and vascular complications are the most frequent major complications. However, in most patients treatment can be conservative and results in complete recovery. Advanced age and congestive heart failure seem to be associated with an increased risk of complications.”
Catheter Ablation Effective in Treating Atrial Fibrillation: Burning faulty tissue better than meds for irregular heartbeat, study suggests “Nearly two-thirds of study participants with atrial fibrillation experienced no such condition-related symptoms one year after having a catheter ablation, a procedure in which heart tissue responsible for the erratic electrical signals throwing off the organ's pumping rhythm is burned and destroyed. Only 17 percent of those in the study treated for the condition with medications reported being arrhythmia-free in the same period. Those who had the surgical procedure also said they experienced a great improvement in their quality of life.“
Prevalence and causes of fatal outcome in catheter ablation of atrial fibrillation. (J Am Coll Cardiol. 2009)
Mortality Risk One in 1000 for Patients Undergoing Catheter Ablation of AF
Complications in the Catheter Ablation of Atrial Fibrillation. (Circ J. 2009)
Transplantation
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