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Review
. 2016 Jan-Mar;6(1):8-16.
doi: 10.4103/2231-0770.173580.

The current approach of atrial fibrillation management

Anish Amin  1 , Aseel Houmsse  1 , Abiodun Ishola  1 , Jaret Tyler  1 , Mahmoud Houmsse  1
Affiliations
Review

The current approach of atrial fibrillation management

Anish Amin et al. Avicenna J Med. 2016 Jan-Mar.

Abstract

Atrial fibrillation (AF) is the most commonly encountered arrhythmia in clinical practice. Aging populations coupled with improved outcomes for many chronic medical conditions has led to increases in AF diagnoses. AF is also known to be associated with an increased risk of adverse events such as transient ischemic attack, ischemic stroke, systemic embolism, and death. This association is enhanced in select populations with preexisting comorbid conditions such as chronic heart failure. The aim of this review is to highlight the advances in the field of cardiology in the management of AF in both acute and long-term settings. We will also review the evolution of anticoagulation management over the past few years and landmark trials in the development of novel oral anticoagulants (NOACs), reversal agents for new NOACs, nonpharmacological options to anticoagulation therapy, and the role of implantable loop recorder in AF management.

Keywords: Antiarrhythmic; anticoagulation; atrial fibrillation; drugs and ablation.

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Figures

Figure 1
Figure 1
Acute Management of new onset atrial fibrillation (LAA: Left atrial appendage; Full anticoagulation: either with 4 consecutive weeks of warfarin therapy with weekly therapeutic INR (2-3) or four weeks of the novel oral anticoagulants (NOACs) without any interruption even for one dose
Figure 2
Figure 2
Management of atrial fibrillation breakthrough with rapid ventricular response (AAD: antiarrhythmic drug; BB: beta blocker; CCB: calcium channel blocker; CHF: chronic heart failure; DCCV: Direct current cardioversion; TEE: Trans-.esophageal echocardiogramand LAA : Left atrial appendage. Full anticoagulation: either with 4 consecutive weeks of warfarin therapy with weekly therapeutic INR (2-3) or four weeks of the novel oral anticoagulants (NOACs) without any interruption even for one dose. Ibutilide is an intravenous AAD, which is usually used for pharmacologic cardioversion in normal heart structure and normal QT interval
Figure 3
Figure 3
Efficacy of anti-arrhythmic drugs on maintaining sinus rhythm (SR: Sinus rhythm; Ablation*: maintained sinus rhythm after one ablation in patients with either paroxysmal and persistent atrial fibrillation
Figure 4
Figure 4
(A,B) Dose adjustment of the novel oral anticoagulants (NOACs) (*Approved dose in the USA) (mg: milligram; po: Oral, Bid: twice daily; CrCL: creatinine clearance; kg: Kilogram; min: minute)
See this image and copyright information in PMC

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