Contemporary Management of Atrial Fibrillation: Update on Anticoagulation and Invasive Management Strategies

Crandall, Mark A.; Bradley, David J.; Packer, Douglas L.; Asirvatham, Samuel J.
July 2009
Mayo Clinic Proceedings;Jul2009, Vol. 84 Issue 7, p643
Academic Journal
Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. its increasing prevalence, particularly among the elderly, renders it one of the most serious current medical epidemics. Several management questions confront the clinician treating a patient with AF: Should the condition be treated? is the patient at risk of death or serious morbidity as a result of this diagnosis? if treatment is necessary, is rate control or rhythm control superior? Which patients need anticoagulation therapy, and for how long? This review of articles obtained by a search of the PubMed and MEDLINE databases presents the available evidence that can guide the clinician in answering these questions. After discussing the merits of available therapy, Including medications aimed at controlling rate, rhythm, or both, we focus on the present status of ablative therapy for AF. Catheter ablation, particularly targeting the pulmonary veins, is being increasingly performed, although the precise indications for this approach and its effectiveness and safety are being actively investigated. We briefly discuss other invasive options that are less frequently used, such as pacemakers, defibrillators, left atrial appendage closure devices, and the surgical maze procedure.


Related Articles

  • Economic Evaluation of Enoxaparin for Anticoagulation in Early Cardioversion of Persisting Nonvalvular Atrial Fibrillation: A Statutory Health Insurance Perspective from Germany. Schädlich, Peter K.; Schmidt-Lucke, Caroline; Huppertz, Eduard; Lehmacher, Walter; Nixdorff, Uwe; Stellbrink, Christoph; Georg Brecht, Josef // American Journal of Cardiovascular Drugs;2007, Vol. 7 Issue 3, p199 

    OBJECTIVE: To estimate, from the perspective of Statutory Health Insurance (SHI, third-party payer) in Germany, the economic consequences of using the subcutaneous low-molecular-weight heparin (LMWH) enoxaparin instead of intravenous unfractionated heparin followed by oral phenprocoumon...

  • Managing the anticoagulated patient with atrial fibrillation at high risk of stroke who needs coronary intervention. Lip, Gregory Y. H. // BMJ: British Medical Journal (International Edition);11/8/2008, Vol. 337 Issue 7678, p1110 

    The article presents an overview of the methods which can be used to manage anticoagulated patients with atrial fibrillation who are at a high risk of stroke and who need coronary intervention. A discussion of research which has been done on side effects which are associated with therapeutics...

  • Clinical decision rules accurately predict stroke risk in atrial fibrillation. Gage, B. F.; Walraven, C.; Pearce, L. // Journal of Family Practice;Apr2005, Vol. 54 Issue 4, p309 

    This article reports that according to a study, clinical decision rules, especially the well- validated Stroke Prevention in Atrial Fibrillation score, can help identify which groups of patients with atrial fibrillation are likely and unlikely to benefit from anticoagulation. If the risk of...

  • Oral anticoagulation in elderly patients as secondary prevention of cardioembolic strokes. Benavente, Lorena; Calleja, Sergio; de la Vega, Vanessa; García, Jorge; Lahoz, Carlos H. // International Archives of Medicine;2010, Vol. 3, p8 

    Background: Stroke incidence increases with age. Atrial fibrillation (AF) is an important risk factor for ischemic stroke and its incidence also increases with age. However oral anticoagulant therapy (OAT) tends to be underused in the elderly population. Methods: Elderly patients (> = 80 years)...

  • Look at evidence on anticoagulants. Lethaby, Anne // New Zealand Doctor;10/20/2004, p30 

    Focuses on the recommended process in prescribing anticoagulant treatment for patients with paroxysmal atrial fibrillation. Appropriate application of risk stratification; Calculation of the patient's risk score for stroke or death; Method in expressing the risks and benefits of alternative...

  • Oral anticoagulant and antiplatelet drugs used in prevention of cardiovascular events in elderly people in Poland. Labuz-Roszak, Beata; Pierzchala, Krystyna; Skrzypek, Michal; Swiech, Marta; Machowska-Majchrzak, Agnieszka // BMC Cardiovascular Disorders;2012, Vol. 12 Issue 1, p98 

    Background: In Poland, the prevalence of cardiovascular diseases is increasing. This might be associated with the constantly growing proportion of elderly people and inappropriate cardiovascular prevention. This study aimed to evaluate the frequency of use of oral antiplatelet (OAP) and oral...

  • ROCKET-AF: Rivaroxaban Prevents Stroke as Effectively as Warfarin, With Lower Bleeding Risk.  // MD Conference Express;Jan2011, p12 

    The article compares the effectiveness of rivaroxaban with warfarin in preventing stroke and noncentral nervous system (CNS) embolism in patients with atrial fibrillation (AF). In the initial analysis of their efficacy, rivaroxaban meets the criteria for noninferiority compared with warfarin....

  • A 60-Year-Old Woman With Atrial Fibrillation. Singer, Daniel E. // JAMA: Journal of the American Medical Association;10/22/2003, Vol. 290 Issue 16, p2182 

    Presents a case of a 60-year-old woman with two year history of paroxysmal atrial fibrillation which progressed into persistent AF. Definition and epidemiology of AF; Risk factors; Classification of AF; Clinical course of the disease; Risks and benefits of anticoagulation; Optimal intensity of...

  • Atrial Fibrillation Treatment Update. Clem, James R. // South Dakota Medicine;Jul2011, p255 

    The article reviews the two areas of change in the atrial fibrillation treatment update which includes ventricular rate control and anticoagulation options for atrial fibrillation. The benefits of strict ventricular rate control were assessed in the Rate Control Efficacy in Permanent Atrial...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics