[The clinical challenge of the atrial fibrillation]

Abstract

Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice. It consists in the triggering of 300 to 600 atrial waves per minute. The ventricular rate depends of the AV node refractory period that without treatment it is very high. This rapid response reduces the ventricular filling period with two consequences, the increase of venous pressures, and the reduction of the cardiac output, determining heart failure and myocardial ischaemia. The lack of atrial contraction, induces thrombus formation with high risk for systemic embolism. Cardioversion of atrial fibrillation is associated with an increased risk of stroke. Thromboembolism happens when atria recover the contraction, that in chronic AF can be several weeks after cardioversion. The management of AF involves three objectives: stroke prevention, rate control, and correction of rhythm disturbance. We need an appropriate approach to antithrombotic therapies for stroke prevention. A proper strategy and safe use of old and new Drugs for rate control or non electrical cardioversion to sinusal rhythm. The useful of statins, ARBII and ACEI for the primary and secondary prevention of AF. For symptomatic patients the electrical managing of the AF is the alternative. Cardioversion is performed as part of a rhythm-control treatment strategy but ablation of the perivenosos pulmonary circuits, ablation of the AV node and implantation of a pacemaker are another alternatives.