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Review
. 2023 Jun 15:10:1060030.
doi: 10.3389/fcvm.2023.1060030. eCollection 2023.

Atrial fibrillation: primary prevention, secondary prevention, and prevention of thromboembolic complications: part 1

Richard G Trohman  1 , Henry D Huang  1 , Parikshit S Sharma  1
Affiliations
Review

Atrial fibrillation: primary prevention, secondary prevention, and prevention of thromboembolic complications: part 1

Richard G Trohman et al. Front Cardiovasc Med. .

Abstract

Atrial fibrillation (AF), is the most common sustained cardiac arrhythmia. It was once thought to be benign as long as the ventricular rate was controlled, however, AF is associated with significant cardiac morbidity and mortality. Increasing life expectancy driven by improved health care and decreased fertility rates has, in most of the world, resulted in the population aged ≥65 years growing more rapidly than the overall population. As the population ages, projections suggest that the burden of AF may increase more than 60% by 2050. Although considerable progress has been made in the treatment and management of AF, primary prevention, secondary prevention, and prevention of thromboembolic complications remain a work in progress. This narrative review was facilitated by a MEDLINE search to identify peer-reviewed clinical trials, randomized controlled trials, meta-analyses, and other clinically relevant studies. The search was limited to English-language reports published between 1950 and 2021. Atrial fibrillation was searched via the terms primary prevention, hyperthyroidism, Wolff-Parkinson-White syndrome, catheter ablation, surgical ablation, hybrid ablation, stroke prevention, anticoagulation, left atrial occlusion and atrial excision. Google and Google scholar as well as bibliographies of identified articles were reviewed for additional references. In these two manuscripts, we discuss the current strategies available to prevent AF, then compare noninvasive and invasive treatment strategies to diminish AF recurrence. In addition, we examine the pharmacological, percutaneous device and surgical approaches to prevent stroke as well as other types of thromboembolic events.

Keywords: catheter ablation—atrial fibrillation; epidemiology; lifestyle modification; pathophysiology; pharmacological interventions.

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Conflict of interest statement

RGT reports serving as an advisor to Boston Scientific/Guidant; receiving research grants from Boston Scientific/Guidant, Medtronic Inc, St Jude Medical (Abbott), Vitatron, and Wyeth-Ayerst/Wyeth Pharmaceuticals; serving as a consultant for Biosense Webster, Alta Thera Pharmaceuticals, and Newron Pharmaceuticals P.s.A.; and receiving speakers fees or honoraria from Boston Scientific/Guidant CRM, Medtronic Inc, Alta Thera Pharmaceuticals, Daichii Sankyo and St Jude Medical (Abbott). The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
AF patient management based on the 2020 ESC guidelines. AHRE, atrial high-rate episode; CIEDs, cardiac implantable electronic devices; EDG, electrocardiogram; NOAC, non-vitamin K antagonist; VKA, vitamin K antagonist. Reproduced from reference (7) with permission.
Figure 2
Figure 2
Systems used for AF screening. Reproduced from reference (40) with permission.
Figure 3
Figure 3
Summary of investigated pharmacological and dietary approaches for primary AF prevention.
Figure 4
Figure 4
(A) during rapid pacing ST segment elevation is present. (B) Atrial fibrillation with a rapid ventricular response was induced. 100 s later, the rhythm degenerated into ventricular which was terminated with a 360 joule shock. Adapted from reference (59) with permission.
Figure 5
Figure 5
Dynamic substrate for atrial fibrillation. Reproduced from reference (235) with permission.
Figure 6
Figure 6
Potentially reversible risk factors. Adapted from reference (236) with permission.
Figure 7
Figure 7
Recommendations for management of patients with AHRE. Reproduced from reference (40) with permission.
See this image and copyright information in PMC

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