+ Resolve Article
+ Follow Us
Follow on FacebookFollow on Facebook
Follow on TwitterFollow on Twitter

+ Translate
+ Subscribe to Site Feed
GeoScience Most Shared ContentMost Shared Content

Treatment of atrial fibrillation

, : Treatment of atrial fibrillation. British Medical Bulletin 88(1): 75-94

Atrial fibrillation (AF) is the most common, sustained rhythm disturbance. The prevalence of AF is increasing as people live longer. Common conditions such as hypertension and ischaemic heart disease play an important role in the development of AF. The presence of AF is associated with increased morbidity and mortality from stroke and heart failure, particularly in patients with structural heart disease. This article provides evidence-based information on the key aspects of managing AF which is based on major guidelines, landmark clinical trials and meta-analyses. It is well recognized that both rate control and rhythm control are important strategies for the management of AF, but each approach should be chosen according to individual patient circumstances. A vast majority of elderly, relatively asymptomatic patients will benefit from ventricular rate control. Embolic stroke remains a major complication of AF. Yet, anticoagulation with warfarin remains underprescribed, especially in the elderly due to the presumed risk of bleeding. The technique of catheter ablation continues to improve and is generally successful in younger patients with relatively normal hearts. There are clinically relevant differences among published schemes designed to stratify stroke risk in patients with AF. The CHADS2 score is currently the most simple system to give some initial estimate of stroke risk in AF patients, but could significantly underestimate this risk, particularly in those who fall in the 'intermediate' risk category.Label="GROWING POINTS AND AREAS TIMELY FOR DEVELOPING RESEARCH" NlmCategory="CONCLUSIONS">Novel antiarrhythmic agents, including atrial specific agents with improved efficacy and safety profile, are currently under development. New antithrombotic agents with efficacy similar to warfarin which do not require regular INR testing appear to be promising, but there are lack of data about their long-term safety. There is increasing evidence that inflammation and fibrosis may play a major role in the initiation and maintenance of AF. Statins by means of their pleotropic effects and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers by preventing atrial remodelling may prove useful in preventing the development of AF. However, there is insufficient evidence to expand the use of these agents to a wider patient population at risk of AF. It needs to be seen if strategies towards primary and secondary prevention with treatment of underlying heart disease and modification of risk factors have a larger effect than specific interventions in preventing the burden of AF in the general population.


PMID: 19059992

DOI: 10.1093/bmb/ldn046

Other references

Sadler, C., 1988: The power of purgatives. Community Outlook: 11-12

Lawrence, D.A.; Schell, R.F., 1978: Susceptibility of C5-deficient mice to listeriosis: modulation by Concanavalin A. Cellular Immunology 39(2): 336-344

Berg V., 1990: Writing abstracts for labs in plant physiology classes. Plant Physiology (Rockville) 93(1 SUPPL): 110

Guinet, R.; Gabriel, S., 1980: Comparison by quantitative immunoelectrophoreses of the antigens of C. albicans groups A and B and of C. tropicalis. Commercial anti-C. albicans group A and a polyspecific anti-C. tropicalis immune serum produced in rabbit were used to compare cytoplasmic soluble extracts of C. albicans group A and group B, and of C. tropicalis. Crossed immuno-electrophoresis (C...

LiangMinShan; JiangQiBin; XiaTianLan, 2008: Study on freezing properties and quality of flammulina velutipes. Freezing patterns and quality changes of <i>Flammulina velutipes</i> were studied at different low temperatures and the changes of PPO and sensory quality were also discussed. The results revealed that, above -37 degrees C, <i>Fl...

Jeanbourquin, Lïc.N.; Scopelliti, R.; Fadaei Tirani, F.; Severin, K., 2017: Synthesis and Reactivity of 1-Allenyltriazenes. 1-Aryl-3,3-dialkyltriazenes have received considerable attention in the context of synthetic and medicinal chemistry. In contrast, the chemistry of other unsaturated triazenes is largely unexplored. The synthesis of 1-allenyltriazenes is described...

Shindo, H.; Torigoe, H.; Sarai, A., 1993: Thermodynamic and kinetic studies of DNA triplex formation of an oligohomopyrimidine and a matched duplex by filter binding assay. The filter binding method was found to be a powerful method for studying the formation of triplexes composed of a single-stranded homopyrimidine and a duplex with a matched purine-pyrimidine tract. With this technique, we were able to determine th...

Chan, M.C.W.; Leung, T.F.; Kwok, A.K.; Lee, N.; Chan, P.K.S., 2014: Characteristics of patients infected with norovirus GII.4 Sydney 2012, Hong Kong, China. Norovirus GII.4 Sydney 2012 has spread globally since late 2012. We report hospitalization of patients infected with this strain skewed toward infants and young children among 174 cases during August 2012-July 2013 in Hong Kong, China. This group...

Pant, H.C.; Singh, G.D., 1980: Control of the oestrous cycle in buffalo with a synthetic analogue of prostaglandin F2 alpha (ICI 80,996). 25 parous females were given a single injection of 500 mu g of the PGF2 alpha analogue between days 5 and 13 of the oestrous cycle. Irrespective of the day of injection, all females came into oestrus within 2-4 days of treatment. Following the syn...

Hille A.; Naumann C.M., 1992: Allozyme differentiation in zygaena transalpina esper 1780 lepidoptera zygaenidae. Dutreix, C , C M Naumann And W G Tremewan (Ed ) Theses Zoologicae, Vol 19 Recent Advances in Burnet Moth Research (Lepidoptera: Zygaenidae); 4th Symposium on Zygaenidae, Nantes, France, September 11-13, 1987 193p Koeltz Scientific Books: Koenigstein, Germany; Champaign, Illinois, Usa Illus Maps 59-87