Cardiovasc Prev Pharmacother.  2024 Jan;6(1):1-7. 10.36011/cpp.2024.6.e4.

Atrial fibrillation: when and how to treat?

• On YK

• KMID: 2551338
• DOI: http://doi.org/10.36011/cpp.2024.6.e4

Abstract

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia, characterized by an irregular and rapid beating of the atria, which results in a loss of effective atrial contraction. The estimated prevalence of AF in the general population is approximately 0.4%. Research on the incidence of AF indicates a significant increase with age. AF presents a significantly higher risk of stroke compared to normal sinus rhythm, with the risk increasing approximately fivefold. It is estimated that around 5% of AF patients suffer a stroke annually. Roughly 20% to 25% of thromboembolic strokes can be attributed to AF, and AF is also associated with a twofold increase in overall mortality. The goals of AF treatment are symptom relief, restoration of normal cardiac function, prevention of thromboembolism, and reduction in mortality. Therefore, the treatment principles can be summarized into three categories: thromboembolism prevention, rate control, and rhythm control. In the treatment of AF, the first step should be to identify and eliminate any underlying causes or triggers. Caution should be exercised regarding the potential for drug-induced arrhythmias or extracardiac side effects. Safety considerations should take precedence over efficacy when selecting antiarrhythmic drugs. Nonpharmacological treatment methods are employed when anti-arrhythmic drug therapy alone is insufficient, particularly in relatively young individuals (under 70 years) without preexisting heart disease, who have experienced frequent transitions from atrial premature contractions or AF instigated by atrial premature contractions. Monitoring the patient's progress is vital, with a focus on comprehensive care for patients with AF.

Figure

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  Fig. 1. Strategies for antiarrhythmic drug use. LVH, left ventricular hypertrophy; LV, left ventricular; ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin-receptor blocker; MRA, mineralocorticoid-receptor antagonist; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; AFCA, atrial fibrillation catheter ablation; AF, atrial fibrillation.

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  Fig. 2. Schematic of atrial fibrillation treatment. (A) Cryoballoon catheter ablation. (B) Radiofrequency catheter ablation.

Reference

1. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomstrom-Lundqvist C, et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021; 42:373–498.

2. Yamanouchi H, Nagura H, Mizutani T, Matsushita S, Esaki Y. Embolic brain infarction in nonrheumatic atrial fibrillation: a clinicopathologic study in the elderly. Neurology. 1997; 48:1593–7.

3. Kirchhof P, Calkins H. Catheter ablation in patients with persistent atrial fibrillation. Eur Heart J. 2017; 38:20–6.

4. Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace. 2018; 20:e1–160.

5. Chen S, Purerfellner H, Ouyang F, Kiuchi MG, Meyer C, Martinek M, et al. Catheter ablation vs. antiarrhythmic drugs as ‘first-line’ initial therapy for atrial fibrillation: a pooled analysis of randomized data. Europace. 2021; 23:1950–60.

6. On YK, Jeong DS. Updates in hybrid AF ablation: a hybrid approach to surgical epicardial ablation and cather endocardial ablation in persistent atrial fibrillation. Int J Arrhythm. 2022; 23:5.