Frequent atrial fibrillation is a common chronic arrhythmia and, although uncommonly fatal, can require careful management. This can be an easy condition to diagnose given at least six weeks of regular episodes followed by an ECG. Treatment aims at prolonging life and preventing cardiovascular complications, as atrial fibrillation with its associated risk factors is recognized as a form of left ventricular (LV) dysfunction. Treatment typically consists of antiarrhythmic medications with careful surveillance of symptoms and cardiovascular complications. Atrial fibrillation is the leading cause of sudden unexplained death, however it is important to recall that arrhythmia occurs and recurs infrequently.
In the European Union, anticholinergic agents (drugs that inhibit the parasympathetic nervous system) are mainly used as the first-line treatment for AF. However, there are currently no well-controlled studies that compare the effectiveness and safety of anticholinergic agents with other types of antiarrhythmic and heart failure therapies in the treatment of AF. This article presents a review of the evidence available for the effectiveness of various non-drug therapies for atrial fibrillation.
Atrial fibrillation is often traced to a history of trauma or infection, abnormalities of cardiac muscle contraction, or abnormal electrical conduction within the atria. If atrial fibrillation presents with symptoms, the differential diagnosis should exclude this diagnoses with an ECG and cardiac catheterization, and exclude the presence of pulmonary artery hypertension.
People with AF have long-term mortality and cardiovascular morbidity, including ischemic stroke. Early recognition of AF is challenging, especially in people with noncardiologic manifestations of AF. The most effective diagnostic method is to detect and diagnose concomitant valvular heart disease, but routine cardiac stress testing is required to identify AF. The electrocardiography is essential as a screening tool in patients with AF of at least 3 months duration with risk factors for embolic stroke (age>or =60, CHADS 2 or CHA2DS2-VASc).
The prevalence of AF is increasing in most of the world, but the number of new cases per 100,000 population remain low, ranging between 0.7 and 2.0 new cases in the developing world and 3.8-15.0 in the developed world. This suggests that one needs to be cautious about the actual prevalence of AF and its prevalence in other populations of the world. One can, at least, be very cautious about extrapolating prevalence from the United States to countries with less experience in the treatment of AF.
In summary, the search for pharmacologic modifiers of the atrial conduction system continues to be largely unsuccessful. There is an urgent need for new and safe interventions for treating the arrhythmia.
Male gender, older age, history of stroke, diabetes and hypertension are the most frequent risk factors for atrial fibrillation in this study. Other risk factors include obesity, myocardial infarction, peripheral vascular disease and previous cardiac surgery. However, the prevalence of the risk factors in patients without atrial fibrillation at presentation suggests that atrial fibrillation is multifactorial.
The goal of cardioversion, ablation, and defibrillation for cardioversion is to revert a patient's arrhythmia to sinus rhythm. Although reversion of AF to sinus rhythm is always indicated as part of pharmacologic therapy, cardioversion is often used as a primary therapy alone. An important consideration for using cardioversion as a primary therapy is the success rate. Although the success rate depends on the arrhythmia and the severity of the arrhythmia, the success rate is higher if cardioversion is followed by antiarrhythmic therapy. A significant number of patients who need cardioversion as the first step in therapy never have an indication for anti-arrhythmic therapy.
The use of combination treatment with catheter, antiarrhythmic drugs, anticoagulant medication, mechanical heart valve replacement, or biologics was not found to be strongly influenced by any other treatments and their usage appeared to be relatively independent of any other possible treatments.
The only group of patients who benefited as much from the placebo pill as from the actual antipyretic (antipyretic) pill were the patients who had previously taken the placebo a long time before. The other two groups did not show any difference in effects. It may be concluded, therefore, from our results that short-term use of an antipyretic drug has no effect, only a placebo effect.
If atrial fibrillation is associated with other cardiothoracic diseases (atherosclerosis, structural heart disease), the aim of treatment of atrial fibrillation is to prevent further damage of the heart and minimize risk of embolization. These factors should therefore be considered when assessing the treatment of atrial fibrillation in all patients.