The majority of embolic stroke in patients with nonvalvular atrial fibrillation (AF) are associated with left atrial appendage (LAA) thrombi.For each anticoagulant, the benefit in terms of stroke reduction must be weighed against the risk of clinically significant bleeding.Due to this safety concern, the PREVAIL (Prospective Randomized Evaluation of the Watchman LAA Closure Device in Patients with Atrial Fibrillation Versus Long-Term Warfarin Therapy) trial was undertaken, in which only 2.2% of the participants developed pericardial effusion.Numerous approaches are used depending on the expertise of the cardiac electrophysiologist and characteristics of the AF.Complications arising from catheter ablation of atrial fibrillation: temporal trends and predictors.
Sotalol is efficacious, but as with other class III drugs, it requires close monitoring of the QT interval and serum electrolyte levels.Enalapril effects on atrial remodeling and atrial fibrillation in experimental congestive heart failure.Cardioversion may be performed electively or emergently to restore sinus rhythm in patients with new-onset AF.Purely right-sided lesions are not sufficient to eliminate AF, making left atrial procedures necessary.No reduction in cardiovascular death, stroke, or myocardial infarction was noted in the patient population studied.The proarrhythmic effect of sotalol is increased in patients with congestive heart failure (unlike dofetilide and amiodarone), so it is generally contraindicated in such patients or in those with a prolonged QT interval.The procedures tend to last many hours, and success rates have been somewhat disappointing (50-60%), with the occurrence of left atrial reentrant tachycardias and left atrial flutters (requiring further ablation procedures).
The need for cardioversion may be acute when AF is responsible for hypotension, heart failure, or angina.Newer oral anticoagulants are attractive alternatives to warfarin in patients with nonvalvular AF.
The image on the right is a reconstructed 3-dimensional image of the left atrium in a patient undergoing atrial fibrillation ablation.
As such, these agents may be used as prophylactic therapy in those at high risk for postoperative AF.The predictive value of this scoring system was evaluated in 90,490 elderly patients with nonvalvular AF who were taking warfarin therapy.An update on atrial fibrillation in 2014: from pathophysiology to treatment.Large clinical trials for the WAVECREST and AMPLATZER devices are under way.
Reduced platelet count or function, including aspirin therapy (1 point).Wallentin L, Yusuf S, Ezekowitz MD, et al, for the RE-LY investigators.Platelets are blood cells that help stop bleeding by bunching together and.This underscores the importance of anticoagulation in both rhythm-control and rate-control patients.Fellow in Cardiovascular Medicine, University of Massachusetts Medical School Disclosure: Nothing to disclose.Circumferential radiofrequency ablation of pulmonary vein ostia: a new anatomic approach for curing atrial fibrillation.
Management and outcomes of major bleeding during treatment with dabigatran or warfarin.Antiarrhythmics After Ablation of Atrial Fibrillation (5A Study).Appropriate management of these risk factors will reduce the likelihood of future episodes of AF and AF-related morbidity and mortality.
Paroxysmal AF is usually caused by triggered and ectopic activity in pulmonary veins, and ablation around the veins terminates the arrhythmia.As discussed previously, AF is often the result of established cardiovascular risk factors.Anticoagulation therapy with warfarin is significantly more effective than antiplatelet therapy (relative risk of 40%) if the international normalized ratio (INR) is adjusted.Surgical ablation of AF is also an option for patients with AF undergoing other cardiac surgery and for those patients in whom pharmacologic and catheter-based procedures are ineffective or contraindicated.
Atrial fibrillation and heart failure due to reduced versus preserved ejection fraction: a systematic review and meta-analysis of death and adverse outcomes.Pierre Borczuk, MD is a member of the following medical societies: American College of Emergency Physicians.Learn how PRADAXA can help reduce the risk of stroke in AFib not caused by a heart valve problem.Electrical cardioversion is also associated with some ST- and T-wave changes on electrocardiography (ECG) and may elevate levels of serum cardiac biomarkers.Administration of preoperative and postoperative beta-blockers is usually sufficient, as postoperative AF is usually paroxysmal and tends to terminate spontaneously.Oral anticoagulants: dabigatran 150 mg BID preferred over warfarin (target INR range, 2.0-3.0).
In 2014, the AAN released level B and C recommendations on the prevention of stroke in patients with nonvalvular AF.Electrical isolation of individual pulmonary veins, and thus the ectopic foci, is performed successfully at many centers, and patient selection is key to success.The WATCHMAN device was found to be noninferior to warfarin therapy for the composite primary end-point of stroke, systemic embolism, and cardiovascular or unexplained death.If rate-control treatment does not elicit a response or if echocardiography does not reveal any valvular or functional abnormality of the heart, cardioversion is indicated.Everett BM, Cook NR, Conen D, Chasman DI, Ridker PM, Albert CM.