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Atrial fibrillation.

Marc Andrews1, Bret P Nelson

  • 1Department of Emergency Medicine, Box 1149, Mount Sinai School of Medicine, One East 100th Street, New York, NY 10029-6574, USA.

The Mount Sinai Journal of Medicine, New York
|February 14, 2006
PubMed
Summary
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Atrial fibrillation affects millions, increasing stroke risk. Current guidelines favor ventricular rate control over rhythm control for better outcomes and fewer side effects.

Area of Science:

  • Cardiology
  • Clinical Medicine

Background:

  • Atrial fibrillation (AF) affects 2.3 million Americans, with numbers projected to rise due to aging.
  • AF signifies physiologic stress and predicts future cardiac disease.
  • It impairs cardiac function, increases metabolic demand, and reduces quality of life.

Purpose of the Study:

  • To review current understanding of atrial fibrillation etiology and treatment.
  • To highlight advances from recent clinical trials.
  • To discuss comprehensive management strategies for AF.

Main Methods:

  • Review of recent large-scale clinical trials.
  • Analysis of risk factors for AF development and stroke.
  • Evaluation of treatment strategies including anticoagulation, rate control, and cardioversion.

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Main Results:

  • Risk factors for AF include diabetes, hypertension, heart failure, valvular disease, and myocardial infarction.
  • AF increases stroke incidence five-fold; anticoagulation (e.g., warfarin) significantly reduces risk.
  • Recent guidelines recommend ventricular rate control over rhythm control due to adverse effects of antiarrhythmic drugs.

Conclusions:

  • Comprehensive AF management involves understanding causes, managing stroke risk with anticoagulation, controlling ventricular rate, and assessing cardioversion risks.
  • Ventricular rate control improves cardiac output, reduces cardiac metabolic demand, and avoids risks associated with rhythm-control drugs.
  • Individualized patient profiles should guide the selection of rate-control agents and cardioversion strategies.