Although AF does not currently have a defined treatment target, recent developments in cardioversion strategies should result in increased use of cardioversion as a first-line intervention.
The mechanism of the initiation of AF from focal electrical activity is incompletely understood. However, since the electrical activity of the atria are intimately linked and are activated and suppressed by the same autonomic pathways, it is unlikely that a single mechanism can cause both initiation and perpetuation of AF. A more comprehensive understanding of the multiple, possibly interlinked, underlying mechanisms that cause atrial fibrillation may illuminate novel potential therapeutic targets.
Some signs of atrial fibrillation include symptoms, such as palpation pain or weakness in the left upper chest. The presence of mitral regurgitation (>or = 1/4 of the diameter) or a first degree atrioventricular block (posterior inferior or posterior lateral wall) increases the risk of atrial fibrillation.
Atrial fibrillation accounts for millions of cases of dyspnea and stroke in the USA. This article describes the characteristics and clinical use of this disorder.
Atrial fibrillation is common and costly. Although the overall incidence of AF has been declining, there have been no significant reductions in hospital visit rates; there is also uncertainty about the impact of AF on long-term mortality and quality-of-life outcomes.
The use of catheter ablation for AF is common despite the lack of evidence for its safety and efficacy. Results from a recent paper, 28% of patients undergo surgical ablation of the substrate of their AF.
Atrial fibrillation is more likely in patients with prior diagnoses of congestive heart failure, diabetes mellitus, hypertension, or alcohol abuse. The magnitude of the alerts is similar to previously published reports in the literature.
More than one-third of atrial fibrillation patients report multiple atrial fibrillation warning criteria on their medical record alerts. The most commonly reported side effects of atrial fibrillation, which have been reported in ≥10% of all alert patients, are headache (28%), flushing (20%), tachycardia (15%) and fatigue (13%) (P<0.05 for all). The number of side effects associated with atrial fibrillation alerts should be decreased by modifying the trigger criterion to a more inclusive criteria and by changing the recommendation for use of beta-blockers in the patient management of atrial fibrillation.
Most patients with atrial fibrillation lack sufficient knowledge to make valid treatment decisions. Inadequate knowledge is primarily associated with age and gender, but not with education, literacy or knowledge of trials. Health care professionals involved in the care of atrial fibrillation patients and their caregivers should emphasize the importance of trials and ensure that patients and their relatives are informed about them. Patients and their families should be encouraged to participate in trials for these therapies.
A new drug called R-axitinib has been approved by FDA for treatment of atrial fibrillation (AF, or AFib). Results of the RE-LY trial showed an overwhelming reduction in the number of patients who were hospitalized for AF (about 28% vs. 53%; p<0.01) within 12 months of starting atrial fibrillation therapy. On the overall (all time points) rate of hospitalizations for AF was lowered by about 42% (<7%) compared with placebo (p<0.001).
Atrial Fibrillation (AF) alerts are often confusing, often due to poor communication on their use, or misapplication which may lead to over-diagnosing and inappropriate drug prescribing, and potentially leading to adverse consequences and unnecessary expenditure. Data from a recent study describes atrial fibrillation screening in the outpatient setting, suggesting more rigorous patient counseling and a clearer message from EHR is needed. All providers (e.g. internal medicine, obstetrics/gynecology, rehabilitation, emergency departments, etc.) will need access to more information and clearer guidelines for implementing an e-learning curriculum in their department.
Atrial fibrillation is diagnosed in a subset of patients in the U.S. with increased frequency, particularly in older adults. The older age at initial diagnosis suggests that AF is under-recognized in this population and would be especially interesting to explore with more population-based studies.