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The causes and management of atrial fibrillation
J H Rudd1, S Maxwell, M Kendall
1Department of Medicine, Queen Elizabeth Hospital, Edgbaston, Birmingham, U.K.
Insights
Atrial fibrillation affects 10% of adults over 65, increasing morbidity and mortality. Treatment focuses on cardioversion, rate control with digoxin, and preventing thromboembolism with anticoagulants and antiplatelet drugs.
Area of Science:
- Cardiology
- Geriatric Medicine
Background:
- Atrial fibrillation (AF) affects ~10% of individuals over 65.
- AF is linked to increased morbidity, mortality, reduced cardiac output, heart failure, and thromboembolic events like stroke.
Purpose of the Study:
- To review the primary treatment aims for atrial fibrillation.
- To discuss strategies for cardioversion, rate control, and thromboembolism prevention.
- To consider specific challenges in treating AF associated with thyrotoxicosis and paroxysmal AF.
Main Methods:
- Literature review of atrial fibrillation management.
- Discussion of pharmacological and electrical cardioversion techniques.
- Analysis of rate control strategies and preventative therapies for thromboembolism.
Main Results:
- Primary goals include terminating AF via cardioversion and preventing recurrence.
- Ventricular rate control with digoxin is crucial if cardioversion fails.
- Anticoagulants and antiplatelet agents are vital for preventing systemic thromboembolic complications.
Conclusions:
- Effective AF management requires addressing underlying causes for successful cardioversion.
- Rate control and thromboembolism prevention are key when cardioversion is not feasible.
- Special considerations exist for treating AF in specific contexts like thyrotoxicosis and paroxysmal presentations.
Abstract:
Atrial fibrillation is present in approximately 10% of the population aged over 65 years, in whom its presence is associated with a significantly increased morbidity and mortality. Principal complications include reduced cardiac output and the precipitation of heart failure and thromboembolic phenomena, including strokes and peripheral emboli. In the majority of cases atrial fibrillation is associated with ischaemic heart-disease and hypertension. Other important causes are thyrotoxicosis, valvular heart-disease and atrial septal defect. The primary aims of treatment in atrial fibrillation are to terminate the arrhythmia (cardioversion) with either drugs or direct current (DC) shock and to prevent its recurrence. Effective cardioversion may necessitate the treatment of underlying pathology. If these primary aims cannot be achieved then an attempt must be made to effectively control the ventricular rate with drugs such as digoxin. Recently, further strong evidence has been provided to support the role of anticoagulants and antiplatelet drugs in preventing the major problem of systemic thromboembolic complications. Some of the special difficulties relating to the treatment of atrial fibrillation associated with thyrotoxicosis as well as paroxysmal atrial fibrillation will also be considered.