Atrial Fibrillation Paper
Stewart S. Other health sites. Acute alcohol consumption can directly trigger an episode of atrial fibrillation. Equine Practice. Although AF and atrial flutter are distinct arrhythmias, atrial flutter may degenerate into Atrial Fibrillation Paper, and an individual may thunder road bruce springsteen both arrhythmias at different times. Short Story: The Four Navaho Gods extreme cases, it can lead to heart failurewhere your heart cannot pump blood Graffiti Persuasive Speech Outline your body as efficiently as before. Results: Fifty-three 1. Predictors and thunder road bruce springsteen of paroxysmal atrial fibrillation in general Alexis De Tocqueville Summary in the UK.
Cardiology Countdown - Atrial Fibrillation - 3 Papers
Abstract Atrial fibrillation AF continues to impose a significant burden upon healthcare resources. Keywords: Atrial fibrillation, arrhythmia, mortality, anti-arrhythmic drugs. AGE Age is a major risk factor for developing AF, and older patients are more likely to have co-morbidities that might impact on survival. SEX In developed societies, healthy females possess a survival advantage over males [ 17 ]. Non-cardiovascular Deaths Most therapeutic strategies for AF such as anti-arrhythmic drugs, anti-thrombotics and catheter ablation can increase mortality risk in AF as a side-effect or serious adverse event. References 1. Feinberg W. Stroke Prevention in Atrial Fibrillation Investigators.
Relationship between prothrombin activation fragment F1. Camm A. Heart J. Stewart S. Kirchhof P. Outcome parameters for trials in atrial fibrillation: executive summary. Benjamin E. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Vidaillet H. A population-based study of mortality among patients with atrial fibrillation or flutter. Risk of mortality in a cohort of patients newly diagnosed with chronic atrial fibrillation.
BMC Cardiovasc. Miyasaka Y. Mortality trends in patients diagnosed with first atrial fibrillation: a year community-based study. Olsson S. Stroke prevention with the oral direct thrombin inhibitor ximelagatran compared with warfarin in patients with non-valvular atrial fibrillation SPORTIF III : randomised controlled trial. Wyse D. A comparison of rate control and rhythm control in patients with atrial fibrillation.
Krahn A. The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study. Gajewski J. Mortality in an insured population with atrial fibrillation. Piccini J. Incidence and prevalence of atrial fibrillation and associated mortality among Medicare beneficiaries, Circ Cardiovasc Qual Outcomes. Hohnloser S. Effect of dronedarone on cardiovascular events in atrial fibrillation. Connolly S. Apixaban in patients with atrial fibrillation. Arias E. National vital statistics reports. United States Life Tables Report No. Time trends of ischemic stroke incidence and mortality in patients diagnosed with first atrial fibrillation in to report of a community-based study.
Turagam M. Rosiak M. Kopecky S. The natural history of lone atrial fibrillation. A population-based study over three decades. Rostagno C. Clinical course of lone atrial fibrillation since first symptomatic arrhythmic episode. Potpara T. Mortality of patients with lone and idiopathic atrial fibrillation is similar to mortality in general population of Serbia. Botto G. Presence and duration of atrial fibrillation detected by continuous monitoring: crucial implications for the risk of thromboembolic events. Lip G. Paroxysmal atrial fibrillation. Keating R. Effect of atrial fibrillation pattern on survival in a community-based cohort. Predictors and prognosis of paroxysmal atrial fibrillation in general practice in the UK.
Tuinenburg A. Lack of prevention of heart failure by serial electrical cardioversion in patients with persistent atrial fibrillation. Brown A. The risk for acute coronary syndrome associated with atrial fibrillation among ED patients with chest pain syndromes. Sankaranarayanan R. Does atrial fibrillation beget ventricular fibrillation in patients with acute myocardial infarction?
Pacing Clin. Lehto M. Roy D. Rhythm control versus rate control for atrial fibrillation and heart failure. Caldwell J. Atrial fibrillation is under-recognized in chronic heart failure: insights from a heart failure cohort treated with cardiac resynchronization therapy. Incidence and mortality risk of congestive heart failure in atrial fibrillation patients: a community-based study over two decades. Wang T. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Olsson L. Atrial fibrillation and risk of clinical events in chronic heart failure with and without left ventricular systolic dysfunction: results from the Candesartan in Heart failure-Assessment of Reduction in Mortality and morbidity CHARM program.
Rivero-Ayerza M. New-onset atrial fibrillation is an independent predictor of in-hospital mortality in hospitalized heart failure patients: results of the EuroHeart Failure Survey. Dries D. Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a retrospective analysis of the SOLVD trials. Studies of Left Ventricular Dysfunction. Mahoney P. Prognostic significance of atrial fibrillation in patients at a tertiary medical center referred for heart transplantation because of severe heart failure. Mamas M. A meta-analysis of the prognostic significance of atrial fibrillation in chronic heart failure.
Heart Fail. Atrial fibrillation in heart failure is associated with an increased risk of death only in patients with ischaemic heart disease. Badheka A. Comparison of mortality and morbidity in patients with atrial fibrillation and heart failure with preserved versus decreased left ventricular ejection fraction. Domanski M. The epidemiology of atrial fibrillation. Artery Dis. Cha Y. Atrial fibrillation and ventricular dysfunction: a vicious electromechanical cycle.
Daoud E. Effect of an irregular ventricular rhythm on cardiac output. Shinbane J. Tachycardia-induced cardiomyopathy: a review of animal models and clinical studies. Steinberg J. Fuster V. Stein K. Jewel AF Worldwide Investigators. Do atrial tachyarrhythmias beget ventricular tachyarrhythmias in defibrillator recipients? Grau A. Risk factors, outcome, and treatment in subtypes of ischemic stroke: the German stroke data bank. Kimura K. Acute stroke with atrial fibrillation. The median time to death was Patients who died early were also less likely to be treated at a higher-volume hospital or academic medical center. Overall, That lines up with what has been shown in the past, and it was nice to see it replicated in our analyses.
The rate of procedural complications during the index admission was 6. He noted, however, they only had access to hospital-level data and not information on individual operators. For that reason, the investigators are unable to precisely say whether the early mortality rate is directly tied to the electrophysiologist. Part of this is the institution as well. Additionally, experience is also likely a factor. The question of minimum volume requirements to perform AF ablations is one that needs to be addressed, said Biviano, noting that select structural heart interventions, such as TAVR, have such minimum standards in place. One of the limitations of the present study is that the causes of death are unknown, so a direct link between the ablation and early mortality is not necessarily the case, he added.
Hospital volume was a very potent predictor of outcomes. Jim Cheung. Wazni advised that physicians need to perform at least 50 A-fib ablations annually to main clinical competency. While studies have shown that ablation is superior to medical therapy in patients with congestive heart failure , those studies limited the severity of disease with cutoffs based on ejection fraction, he said. The present NRD analysis does not include data on ejection fraction, but congestive heart failure was a leading cause of hospital readmission and a predictor of mortality.
At the Cleveland Clinic, there have been two deaths following A-fib ablation since their series was published, but these two patients were extremely sick, said Wazni. Thus far, clinicians at their center have ablated more than 20, patients with A-fib. In his editorial, Calkins also stresses the importance of operator experience. In that study, annual operator volume less than 25 procedures and hospital volume less than 50 procedures were significantly associated with adverse outcomes. Risk of mortality following catheter ablation of atrial fibrillation. J Am Coll Cardiol. Calkins H. When it comes to the mortality rates of catheter ablation of atrial fibrillation, experience matters. Stay up-to-date with breaking news, conference slides, and topical videos covering the spectrum of CVD.
Join our newsletter! This association is enhanced in select populations with preexisting comorbid conditions such as chronic heart failure. The aim of this review is to highlight the advances in the field of cardiology in the management of AF in both acute and long-term settings. We will also review the evolution of anticoagulation management over the past few years and landmark trials in the development of novel oral anticoagulants NOACs , reversal agents for new NOACs, nonpharmacological options to anticoagulation therapy, and the role of implantable loop recorder in AF management.
The prevalence of atrial fibrillation AF ranges from 0. There is an increased prevalence of AF in age-adjusted male population as compared to women. Caucasians have a higher prevalence of AF at 2. This shows the strong correlation between worsening cardiac function, age, and AF. AF requires a trigger to begin. The trigger is usually in the form of either automatic foci of tachycardia or multiple wavelets extending through the left atrium. The substrate used for maintenance of arrhythmia is commonly heterogeneous tissue.
Enhanced focal automaticity occurs most commonly in the pulmonary veins PVs , which generate microreentrant circuits that extend into adjacent left atrial tissue. The risk of thromboembolism persists even after cardioversion secondary to a phenomenon known as atrial stunning. Atrial dysfunction is most pronounced immediately following restoration of sinus rhythm and abates typically within days but has been described as far out as 3—4 weeks. Initial encounters with patients with AF should focus on the hemodynamic stability. Hemodynamic instability results from compromised ventricular diastolic filling and myocardial oxygen delivery, particularly in patients with AF with rapid ventricular response.
In the absence of hemodynamic compromise the management of AF is guided by symptomatology and its duration [ Figure 1 ]. This specifically involves identifying exercise capacity and functional capacity, which is inferred from generalized complaints of fatigue and the absence or presence of syncope. Establishing the presence or absence of symptoms and their duration in AF patients is paramount in making decisions regarding long-term rate versus rhythm control strategy.
Lastly, it is important to identify and effectively manage other risk factors such as obesity, thyroid disorder, and sleep apnea. Acute Management of new onset atrial fibrillation LAA: Left atrial appendage; Full anticoagulation: either with 4 consecutive weeks of warfarin therapy with weekly therapeutic INR or four weeks of the novel oral anticoagulants NOACs without any interruption even for one dose. Patients presenting with evidence of hemodynamic or myocardial compromise should receive immediate interventions to restore sinus rhythm or rapidly reduce ventricular rates. In the absence of hemodynamic instability, synchronized direct-current cardioversion DCCV should be an elective procedure.
Particular attention should be given to the ability of patients to tolerate anticoagulation for at least 4 weeks post DCCV. For acute rate control, beta blockade BB , calcium channel blockade CCB , digoxin, or amiodarone may be considered. Selection of one agent over another is guided primarily by comorbid conditions including the presence or absence of CHF and the potential for an existing accessory pathway of atrioventricular AV conduction preexcitation. Beta-adrenergic antagonists are most effective in states of high catecholamine release, including the perioperative period and critical illness. Intravenous esmolol BB and diltiazem CCB have similar heart rates achieved at 2 and 12 h, respectively.
Both portend a negative inotropic effect in concert with preferential AV node slowing which may accelerate ventricular activation in patients with accessory pathways leading to ventricular rate acceleration and ventricular fibrillation. In the setting of a patient with CHF, consideration may be given to digoxin though a vagotonic mechanism of action digoxin may transiently slow AV conduction.
In the setting of advanced CHF or preexcitation amiodarone may be considered. Full anticoagulation: either with 4 consecutive weeks of warfarin therapy with weekly therapeutic INR or four weeks of the novel oral anticoagulants NOACs without any interruption even for one dose. Ibutilide is an intravenous AAD, which is usually used for pharmacologic cardioversion in normal heart structure and normal QT interval. Long-term management of AF involves effectively managing symptoms with either rate or rhythm control strategies in addition to prevention of thromboembolism. These goals are not mutually exclusive.
Quality of life QOL evaluations have demonstrated no significant difference between patients ascribed to rate control strategies versus those placed on rhythm control strategies, with the exception of one study; which was a status postsurgical Maze procedures. Similarly, concurrent anticoagulant therapy appears to negatively affect perceived QOL. However, novel anticoagulants are significantly reducing the burden associated with routine anticoagulation monitoring. Oral BB has been shown to be the best single agent for rate control. Digoxin is used in patients with CHF. AV node and permanent pacemaker are a well-established rate control strategy in medically refractory AF.
Significant improvement in QOL, left ventricular ejection fraction LVEF as well as exercise endurance improves in patients who underwent AV node ablation and pacing as a rate control strategy. Antiarrhythmic therapy is tailored upon structural cardiac features and guided by evidence-based both on the type of AF and side effect profile of the antiarrhythmic drugs AAD considered. Classification of the AAD is based on the mechanism of action. Flecainide increases in mortality in patients with coronary artery disease. Dofetilide is a class III AAD and has been established as an appropriate antiarrhythmic option in patients with structurally normal hearts as well as those with CHF or prior myocardial infarction.
Amiodarone is a multichannel AAD. Amiodarone has been shown to be superior to sotalol and propafenone in maintaining sinus rhythm in paroxysmal and persistent AF. It is related to amiodarone but lacks the iodine moieties with the expectation of reducing toxic effects on the thyroid, lungs, and liver. Therefore, we recommend checking liver function test frequently in the first few weeks. The relatively low rates of success for AADs coupled with the specific long-term potential side effects have resulted in ablative therapy as an alternative second-line therapy for the maintenance of sinus rhythm. Current protocols seek to isolate the PVs via radiofrequency ablation or balloon cryoablation.
Catheter radiofrequency ablation or balloon cryoablation is superior over AADs in patients with paroxysmal or persistent AF. Complications of AF ablation therapy have been reported in 4. Death accounts for 0. Atrio-esophageal AE fistula is the deadly complication and accounted for 0. Other complications include cardiac tamponade 1. Minor complications include femoral pseudoaneurysm and arteriovenous fistula. Absolute contraindications to ablation include intolerance to anticoagulation. This is since anticoagulation therapy is required postablation. The presence of LAA thrombus is also an indication as well as severe mitral valve disease or mechanical mitral valve prosthesis and severe pulmonary hypertension.
Regardless of the strategy of symptom control, every patient needs to be evaluated for thromboembolic risk. An appropriate strategy must also be identified at the time of diagnosis and re-evaluated with each clinical encounter. Maintenance of anticoagulation in the immediate setting is critical to prevent systemic thromboembolism including stroke following pharmacologic or electrical cardioversion, which occurs within the first 3 days of restoration of sinus rhythm.
Epidemiologic studies showed the lowest incidence of thromboembolism at 1. A history of ischemic stroke or TIA is the largest single risk factor for recurrent stroke with a relative risk of 2. Echocardiographic evidence of CHF is an independent risk factor for stroke. The rationale for anticoagulant or antiplatelet therapy should be guided by the interaction of these known risk factors. Aspirin has been evaluated independently in 6 trials. A meta-analysis of this demonstrates only marginal protection against stroke with a stroke rate of 1. Similarly, high-risk populations benefit most from oral anticoagulation compared to aspirin therapy. It has a slow onset that often requires bridging with intravenous heparin or subcutaneous low molecular heparin.
Hemodialysis can rapidly reduce the dabigatran blood concentration and anticoagulant effect for few hours. Dabigatran is noninferior to warfarin in preventing systemic thromboembolism. Dabigatran has significantly lower incidence of hemorrhagic stroke, but a higher incidence of gastrointestinal bleeding compared to warfarin therapy. The recommended dose is 5 mg twice daily for patients with nonvalvular AF and preserved renal function. Apixaban 2. Apixaban is not only more effective than warfarin at preventing stroke, but also safer in terms of bleeding risk and risk of death.
Edoxaban is associated with significantly lower rates of bleeding and death from cardiovascular causes compared to warfarin.Vidaillet H. Effective anticoagulation is the thunder road bruce springsteen effective method of reducing mortality in AF Knee Replacement Facts Essay [ 92 ]. Kopecky S.