Skip to main navigation menu Skip to main content Skip to site footer

Review article: Biomedical intelligence

Vol. 150 No. 1112 (2020)

Atrial fibrillation for internists: current practice

DOI
https://doi.org/10.4414/smw.2020.20196
Cite this as:
Swiss Med Wkly. 2020;150:w20196
Published
22.03.2020

Abstract

Atrial fibrillation (AF) has become a global epidemic and puts affected patients at high risk of adverse events. In this review we summarise the current evidence on risk factors and complications of AF, describe current treatment strategies, and outline new fields of research. Current evidence shows that hypertension and obesity are the two most important modifiable risk factors for the development of AF. Patients with AF face an increased stroke risk. Oral anticoagulation reduces this risk substantially. Mainly for reasons of safety and ease of use, non-vitamin K antagonist oral anticoagulants are preferred for stroke prevention. Rate and rhythm control interventions remain important and are mainly used for symptom control in AF patients. Rate control is recommended as an initial treatment and in patients with a low or absent symptom burden. Following the advent of AF ablation 20 years ago, the chances of successful sustained rhythm control have increased. Nevertheless, the procedural risks, although low, must be discussed with the patient in the context of the potential benefits. Heart failure and AF often coexist, which creates a further challenge for optimal AF management. Recent studies have shown that AF patients have a high burden of silent brain lesions, and that these lesions are associated with cognitive dysfunction. A better understanding of these interrelationships may eventually help the development of new prevention and treatment strategies to decrease the burden and complications associated with AF.

References

  1. Krijthe BP, Kunst A, Benjamin EJ, Lip GY, Franco OH, Hofman A, et al. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J. 2013;34(35):2746–51. doi:.https://doi.org/10.1093/eurheartj/eht280
  2. Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Bailey KR, Abhayaratna WP, et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation. 2006;114(2):119–25. doi:.https://doi.org/10.1161/CIRCULATIONAHA.105.595140
  3. Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285(18):2370–5. doi:.https://doi.org/10.1001/jama.285.18.2370
  4. Staerk L, Wang B, Preis SR, Larson MG, Lubitz SA, Ellinor PT, et al. Lifetime risk of atrial fibrillation according to optimal, borderline, or elevated levels of risk factors: cohort study based on longitudinal data from the Framingham Heart Study. BMJ. 2018;361:k1453. doi:.https://doi.org/10.1136/bmj.k1453
  5. Heeringa J, van der Kuip DA, Hofman A, Kors JA, van Herpen G, Stricker BH, et al. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J. 2006;27(8):949–53. doi:.https://doi.org/10.1093/eurheartj/ehi825
  6. Magnussen C, Niiranen TJ, Ojeda FM, Gianfagna F, Blankenberg S, Njølstad I, et al.; BiomarCaRE Consortium. Sex Differences and Similarities in Atrial Fibrillation Epidemiology, Risk Factors, and Mortality in Community Cohorts: Results From the BiomarCaRE Consortium (Biomarker for Cardiovascular Risk Assessment in Europe). Circulation. 2017;136(17):1588–97. doi:.https://doi.org/10.1161/CIRCULATIONAHA.117.028981
  7. Conen D, Tedrow UB, Koplan BA, Glynn RJ, Buring JE, Albert CM. Influence of systolic and diastolic blood pressure on the risk of incident atrial fibrillation in women. Circulation. 2009;119(16):2146–52. doi:.https://doi.org/10.1161/CIRCULATIONAHA.108.830042
  8. Tedrow UB, Conen D, Ridker PM, Cook NR, Koplan BA, Manson JE, et al. The long- and short-term impact of elevated body mass index on the risk of new atrial fibrillation the WHS (women’s health study). J Am Coll Cardiol. 2010;55(21):2319–27. doi:.https://doi.org/10.1016/j.jacc.2010.02.029
  9. Schoen T, Pradhan AD, Albert CM, Conen D. Type 2 diabetes mellitus and risk of incident atrial fibrillation in women. J Am Coll Cardiol. 2012;60(15):1421–8. doi:.https://doi.org/10.1016/j.jacc.2012.06.030
  10. Benjamin EJ, Levy D, Vaziri SM, D’Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA. 1994;271(11):840–4. doi:.https://doi.org/10.1001/jama.1994.03510350050036
  11. Wang TJ, Larson MG, Levy D, Vasan RS, Leip EP, Wolf PA, et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation. 2003;107(23):2920–5. doi:.https://doi.org/10.1161/01.CIR.0000072767.89944.6E
  12. Conen D, Chae CU, Glynn RJ, Tedrow UB, Everett BM, Buring JE, et al. Risk of death and cardiovascular events in initially healthy women with new-onset atrial fibrillation. JAMA. 2011;305(20):2080–7. doi:.https://doi.org/10.1001/jama.2011.659
  13. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22(8):983–8. doi:.https://doi.org/10.1161/01.STR.22.8.983
  14. Ott A, Breteler MM, de Bruyne MC, van Harskamp F, Grobbee DE, Hofman A. Atrial fibrillation and dementia in a population-based study. The Rotterdam Study. Stroke. 1997;28(2):316–21. doi:.https://doi.org/10.1161/01.STR.28.2.316
  15. Thrall G, Lane D, Carroll D, Lip GY. Quality of life in patients with atrial fibrillation: a systematic review. Am J Med. 2006;119(5):448.e1–19. doi:.https://doi.org/10.1016/j.amjmed.2005.10.057
  16. Wolf PA, Dawber TR, Thomas HE, Jr, Kannel WB. Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study. Neurology. 1978;28(10):973–7. doi:.https://doi.org/10.1212/WNL.28.10.973
  17. Kalantarian S, Stern TA, Mansour M, Ruskin JN. Cognitive impairment associated with atrial fibrillation: a meta-analysis. Ann Intern Med. 2013;158(5 Pt 1):338–46. doi:.https://doi.org/10.7326/0003-4819-158-5-201303050-00007
  18. Manolis AJ, Rosei EA, Coca A, Cifkova R, Erdine SE, Kjeldsen S, et al. Hypertension and atrial fibrillation: diagnostic approach, prevention and treatment. Position paper of the Working Group ‘Hypertension Arrhythmias and Thrombosis’ of the European Society of Hypertension. J Hypertens. 2012;30(2):239–52. doi:.https://doi.org/10.1097/HJH.0b013e32834f03bf
  19. Huxley RR, Lopez FL, Folsom AR, Agarwal SK, Loehr LR, Soliman EZ, et al. Absolute and attributable risks of atrial fibrillation in relation to optimal and borderline risk factors: the Atherosclerosis Risk in Communities (ARIC) study. Circulation. 2011;123(14):1501–8. doi:.https://doi.org/10.1161/CIRCULATIONAHA.110.009035
  20. Verdecchia P, Angeli F, Reboldi G. Hypertension and Atrial Fibrillation: Doubts and Certainties From Basic and Clinical Studies. Circ Res. 2018;122(2):352–68. doi:.https://doi.org/10.1161/CIRCRESAHA.117.311402
  21. Wang TJ, Parise H, Levy D, D’Agostino RB, Sr, Wolf PA, Vasan RS, et al. Obesity and the risk of new-onset atrial fibrillation. JAMA. 2004;292(20):2471–7. doi:.https://doi.org/10.1001/jama.292.20.2471
  22. Lauer MS, Anderson KM, Kannel WB, Levy D. The impact of obesity on left ventricular mass and geometry. The Framingham Heart Study. JAMA. 1991;266(2):231–6. doi:.https://doi.org/10.1001/jama.1991.03470020057032
  23. Vincent HK, Powers SK, Stewart DJ, Shanely RA, Demirel H, Naito H. Obesity is associated with increased myocardial oxidative stress. Int J Obes Relat Metab Disord. 1999;23(1):67–74. doi:.https://doi.org/10.1038/sj.ijo.0800761
  24. Ettinger PO, Wu CF, De La Cruz C, Jr, Weisse AB, Ahmed SS, Regan TJ. Arrhythmias and the “Holiday Heart”: alcohol-associated cardiac rhythm disorders. Am Heart J. 1978;95(5):555–62. doi:.https://doi.org/10.1016/0002-8703(78)90296-X
  25. Djoussé L, Levy D, Benjamin EJ, Blease SJ, Russ A, Larson MG, et al. Long-term alcohol consumption and the risk of atrial fibrillation in the Framingham Study. Am J Cardiol. 2004;93(6):710–3. doi:.https://doi.org/10.1016/j.amjcard.2003.12.004
  26. Conen D, Tedrow UB, Cook NR, Moorthy MV, Buring JE, Albert CM. Alcohol consumption and risk of incident atrial fibrillation in women. JAMA. 2008;300(21):2489–96. doi:.https://doi.org/10.1001/jama.2008.755
  27. Larsson SC, Drca N, Wolk A. Alcohol consumption and risk of atrial fibrillation: a prospective study and dose-response meta-analysis. J Am Coll Cardiol. 2014;64(3):281–9. doi:.https://doi.org/10.1016/j.jacc.2014.03.048
  28. Qiao Y, Shi R, Hou B, Wu L, Zheng L, Ding L, et al. Impact of Alcohol Consumption on Substrate Remodeling and Ablation Outcome of Paroxysmal Atrial Fibrillation. J Am Heart Assoc. 2015;4(11):e002349. doi:.https://doi.org/10.1161/JAHA.115.002349
  29. McManus DD, Yin X, Gladstone R, Vittinghoff E, Vasan RS, Larson MG, et al. Alcohol Consumption, Left Atrial Diameter, and Atrial Fibrillation. J Am Heart Assoc. 2016;5(9):e004060. doi:.https://doi.org/10.1161/JAHA.116.004060
  30. Cornelissen VA, Fagard RH. Effects of endurance training on blood pressure, blood pressure-regulating mechanisms, and cardiovascular risk factors. Hypertension. 2005;46(4):667–75. doi:.https://doi.org/10.1161/01.HYP.0000184225.05629.51
  31. Sluik D, Buijsse B, Muckelbauer R, Kaaks R, Teucher B, Johnsen NF, et al. Physical Activity and Mortality in Individuals With Diabetes Mellitus: A Prospective Study and Meta-analysis. Arch Intern Med. 2012;172(17):1285–95. doi:.https://doi.org/10.1001/archinternmed.2012.3130
  32. Jakicic JM, Marcus BH, Gallagher KI, Napolitano M, Lang W. Effect of exercise duration and intensity on weight loss in overweight, sedentary women: a randomized trial. JAMA. 2003;290(10):1323–30. doi:.https://doi.org/10.1001/jama.290.10.1323
  33. Bhella PS, Hastings JL, Fujimoto N, Shibata S, Carrick-Ranson G, Palmer MD, et al. Impact of lifelong exercise “dose” on left ventricular compliance and distensibility. J Am Coll Cardiol. 2014;64(12):1257–66. doi:.https://doi.org/10.1016/j.jacc.2014.03.062
  34. Drca N, Wolk A, Jensen-Urstad M, Larsson SC. Physical activity is associated with a reduced risk of atrial fibrillation in middle-aged and elderly women. Heart. 2015;101(20):1627–30. doi:.https://doi.org/10.1136/heartjnl-2014-307145
  35. Mozaffarian D, Furberg CD, Psaty BM, Siscovick D. Physical activity and incidence of atrial fibrillation in older adults: the cardiovascular health study. Circulation. 2008;118(8):800–7. doi:.https://doi.org/10.1161/CIRCULATIONAHA.108.785626
  36. Aizer A, Gaziano JM, Cook NR, Manson JE, Buring JE, Albert CM. Relation of vigorous exercise to risk of atrial fibrillation. Am J Cardiol. 2009;103(11):1572–7. doi:.https://doi.org/10.1016/j.amjcard.2009.01.374
  37. Andersen K, Farahmand B, Ahlbom A, Held C, Ljunghall S, Michaëlsson K, et al. Risk of arrhythmias in 52 755 long-distance cross-country skiers: a cohort study. Eur Heart J. 2013;34(47):3624–31. doi:.https://doi.org/10.1093/eurheartj/eht188
  38. Thelle DS, Selmer R, Gjesdal K, Sakshaug S, Jugessur A, Graff-Iversen S, et al. Resting heart rate and physical activity as risk factors for lone atrial fibrillation: a prospective study of 309,540 men and women. Heart. 2013;99(23):1755–60. doi:.https://doi.org/10.1136/heartjnl-2013-303825
  39. Abdulla J, Nielsen JR. Is the risk of atrial fibrillation higher in athletes than in the general population? A systematic review and meta-analysis. Europace. 2009;11(9):1156–9. doi:.https://doi.org/10.1093/europace/eup197
  40. Wilhelm M, Roten L, Tanner H, Wilhelm I, Schmid JP, Saner H. Atrial remodeling, autonomic tone, and lifetime training hours in nonelite athletes. Am J Cardiol. 2011;108(4):580–5. doi:.https://doi.org/10.1016/j.amjcard.2011.03.086
  41. Fortescue EB, Shin AY, Greenes DS, Mannix RC, Agarwal S, Feldman BJ, et al. Cardiac troponin increases among runners in the Boston Marathon. Ann Emerg Med. 2007;49(2):137–43.e1. doi:.https://doi.org/10.1016/j.annemergmed.2006.09.024
  42. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al.; ESC Scientific Document Group. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893–962. doi:.https://doi.org/10.1093/eurheartj/ehw210
  43. Kishore A, Vail A, Majid A, Dawson J, Lees KR, Tyrrell PJ, et al. Detection of atrial fibrillation after ischemic stroke or transient ischemic attack: a systematic review and meta-analysis. Stroke. 2014;45(2):520–6. doi:.https://doi.org/10.1161/STROKEAHA.113.003433
  44. Sanna T, Diener HC, Passman RS, Di Lazzaro V, Bernstein RA, Morillo CA, et al.; CRYSTAL AF Investigators. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med. 2014;370(26):2478–86. doi:.https://doi.org/10.1056/NEJMoa1313600
  45. Gladstone DJ, Spring M, Dorian P, Panzov V, Thorpe KE, Hall J, et al.; EMBRACE Investigators and Coordinators. Atrial fibrillation in patients with cryptogenic stroke. N Engl J Med. 2014;370(26):2467–77. doi:.https://doi.org/10.1056/NEJMoa1311376
  46. Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA. 2001;285(22):2864–70. doi:.https://doi.org/10.1001/jama.285.22.2864
  47. The SPAF III Writing Committee for the Stroke Prevention in Atrial Fibrillation Investigators. Patients with nonvalvular atrial fibrillation at low risk of stroke during treatment with aspirin: Stroke Prevention in Atrial Fibrillation III Study. JAMA. 1998;279(16):1273–7. doi:.https://doi.org/10.1001/jama.279.16.1273
  48. Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2010;137(2):263–72. doi:.https://doi.org/10.1378/chest.09-1584
  49. Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014;383(9921):955–62. doi:.https://doi.org/10.1016/S0140-6736(13)62343-0
  50. Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007;146(12):857–67. doi:.https://doi.org/10.7326/0003-4819-146-12-200706190-00007
  51. Zimny M, Blum S, Ammann P, Erne P, Moschovitis G, Di Valentino M, et al. Uptake of non-vitamin K antagonist oral anti coagulants in patients with atrial fibrillation - a prospective cohort study. Swiss Med Wkly. 2017;147:w14410.
  52. Stroke Prevention in Atrial Fibrillation Study. Final results. Circulation. 1991;84(2):527–39. doi:.https://doi.org/10.1161/01.CIR.84.2.527
  53. Olesen JB, Lip GY, Lindhardsen J, Lane DA, Ahlehoff O, Hansen ML, et al. Risks of thromboembolism and bleeding with thromboprophylaxis in patients with atrial fibrillation: A net clinical benefit analysis using a ‘real world’ nationwide cohort study. Thromb Haemost. 2011;106(4):739–49.
  54. Själander S, Själander A, Svensson PJ, Friberg L. Atrial fibrillation patients do not benefit from acetylsalicylic acid. Europace. 2014;16(5):631–8. doi:.https://doi.org/10.1093/europace/eut333
  55. Connolly S, Pogue J, Hart R, Pfeffer M, Hohnloser S, Chrolavicius S, et al., ACTIVE Writing Group of the ACTIVE Investigators. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial. Lancet. 2006;367(9526):1903–12. doi:.https://doi.org/10.1016/S0140-6736(06)68845-4
  56. Connolly SJ, Pogue J, Hart RG, Hohnloser SH, Pfeffer M, Chrolavicius S, et al., ACTIVE Investigators. Effect of clopidogrel added to aspirin in patients with atrial fibrillation. N Engl J Med. 2009;360(20):2066–78. doi:.https://doi.org/10.1056/NEJMoa0901301
  57. Göldi T, Krisai P, Knecht S, Aeschbacher S, Spies F, Zeljkovic I, et al. Prevalence and Management of Atrial Thrombi in Patients With Atrial Fibrillation Before Pulmonary Vein Isolation. JACC Clin Electrophysiol. 2019;5(12):1406–14. doi:.https://doi.org/10.1016/j.jacep.2019.09.003
  58. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, 3rd, Feldman HI, et al.; CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–12. doi:.https://doi.org/10.7326/0003-4819-150-9-200905050-00006
  59. Siontis KC, Zhang X, Eckard A, Bhave N, Schaubel DE, He K, et al. Outcomes Associated With Apixaban Use in Patients With End-Stage Kidney Disease and Atrial Fibrillation in the United States. Circulation. 2018;138(15):1519–29. doi:.https://doi.org/10.1161/CIRCULATIONAHA.118.035418
  60. Steffel J, Verhamme P, Potpara TS, Albaladejo P, Antz M, Desteghe L, et al.; ESC Scientific Document Group. The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J. 2018;39(16):1330–93. doi:.https://doi.org/10.1093/eurheartj/ehy136
  61. Ray WA, Chung CP, Murray KT, Smalley WE, Daugherty JR, Dupont WD, et al. Association of Proton Pump Inhibitors With Reduced Risk of Warfarin-Related Serious Upper Gastrointestinal Bleeding. Gastroenterology. 2016;151(6):1105–12.e10. doi:.https://doi.org/10.1053/j.gastro.2016.08.054
  62. Di Minno A, Spadarella G, Spadarella E, Tremoli E, Di Minno G. Gastrointestinal bleeding in patients receiving oral anticoagulation: Current treatment and pharmacological perspectives. Thromb Res. 2015;136(6):1074–81. doi:.https://doi.org/10.1016/j.thromres.2015.10.016
  63. Chan EW, Lau WC, Leung WK, Mok MT, He Y, Tong TS, et al. Prevention of Dabigatran-Related Gastrointestinal Bleeding With Gastroprotective Agents: A Population-Based Study. Gastroenterology. 2015;149(3):586–95.e3. doi:.https://doi.org/10.1053/j.gastro.2015.05.002
  64. Schreck DM, Rivera AR, Tricarico VJ. Emergency management of atrial fibrillation and flutter: intravenous diltiazem versus intravenous digoxin. Ann Emerg Med. 1997;29(1):135–40. doi:.https://doi.org/10.1016/S0196-0644(97)70319-6
  65. Tisdale JE, Padhi ID, Goldberg AD, Silverman NA, Webb CR, Higgins RS, et al. A randomized, double-blind comparison of intravenous diltiazem and digoxin for atrial fibrillation after coronary artery bypass surgery. Am Heart J. 1998;135(5 Pt 1):739–47. doi:.https://doi.org/10.1016/S0002-8703(98)70031-6
  66. Scheuermeyer FX, Grafstein E, Stenstrom R, Christenson J, Heslop C, Heilbron B, et al. Safety and efficiency of calcium channel blockers versus beta-blockers for rate control in patients with atrial fibrillation and no acute underlying medical illness. Acad Emerg Med. 2013;20(3):222–30. doi:.https://doi.org/10.1111/acem.12091
  67. Kühlkamp V, Bosch R, Mewis C, Seipel L. Use of beta-blockers in atrial fibrillation. Am J Cardiovasc Drugs. 2002;2(1):37–42. doi:.https://doi.org/10.2165/00129784-200202010-00005
  68. Kotecha D, Holmes J, Krum H, Altman DG, Manzano L, Cleland JG, et al.; Beta-Blockers in Heart Failure Collaborative Group. Efficacy of β blockers in patients with heart failure plus atrial fibrillation: an individual-patient data meta-analysis. Lancet. 2014;384(9961):2235–43. doi:.https://doi.org/10.1016/S0140-6736(14)61373-8
  69. Kotecha D, Manzano L, Krum H, Rosano G, Holmes J, Altman DG, et al.; Beta-Blockers in Heart Failure Collaborative Group. Effect of age and sex on efficacy and tolerability of β blockers in patients with heart failure with reduced ejection fraction: individual patient data meta-analysis. BMJ. 2016;353:i1855. doi:.https://doi.org/10.1136/bmj.i1855
  70. Nikolaidou T, Channer KS. Chronic atrial fibrillation: a systematic review of medical heart rate control management. Postgrad Med J. 2009;85(1004):303–12. doi:.https://doi.org/10.1136/pgmj.2008.068908
  71. Goldstein RE, Boccuzzi SJ, Cruess D, Nattel S. Diltiazem increases late-onset congestive heart failure in postinfarction patients with early reduction in ejection fraction. The Adverse Experience Committee; and the Multicenter Diltiazem Postinfarction Research Group. Circulation. 1991;83(1):52–60. doi:.https://doi.org/10.1161/01.CIR.83.1.52
  72. Goldberger ZD, Alexander GC. Digitalis use in contemporary clinical practice: refitting the foxglove. JAMA Intern Med. 2014;174(1):151–4. doi:.https://doi.org/10.1001/jamainternmed.2013.10432
  73. Digitalis Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med. 1997;336(8):525–33. doi:.https://doi.org/10.1056/NEJM199702203360801
  74. Lim KT, Davis MJ, Powell A, Arnolda L, Moulden K, Bulsara M, et al. Ablate and pace strategy for atrial fibrillation: long-term outcome of AIRCRAFT trial. Europace. 2007;9(7):498–505. doi:.https://doi.org/10.1093/europace/eum091
  75. Brignole M, Pokushalov E, Pentimalli F, Palmisano P, Chieffo E, Occhetta E, et al.; APAF-CRT Investigators. A randomized controlled trial of atrioventricular junction ablation and cardiac resynchronization therapy in patients with permanent atrial fibrillation and narrow QRS. Eur Heart J. 2018;39(45):3999–4008. doi:.https://doi.org/10.1093/eurheartj/ehy555
  76. Arenja N, Knecht S, Schaer B, Reichlin T, Pavlovic N, Osswald S, et al. Comparison of different approaches to atrioventricular junction ablation and pacemaker implantation in patients with atrial fibrillation. Pacing Clin Electrophysiol. 2014;37(12):1686–93. doi:.https://doi.org/10.1111/pace.12481
  77. Roy D, Talajic M, Dorian P, Connolly S, Eisenberg MJ, Green M, et al.; Canadian Trial of Atrial Fibrillation Investigators. Amiodarone to prevent recurrence of atrial fibrillation. N Engl J Med. 2000;342(13):913–20. doi:.https://doi.org/10.1056/NEJM200003303421302
  78. Singh BN, Connolly SJ, Crijns HJ, Roy D, Kowey PR, Capucci A, et al.; EURIDIS and ADONIS Investigators. Dronedarone for maintenance of sinus rhythm in atrial fibrillation or flutter. N Engl J Med. 2007;357(10):987–99. doi:.https://doi.org/10.1056/NEJMoa054686
  79. Singh BN, Singh SN, Reda DJ, Tang XC, Lopez B, Harris CL, et al.; Sotalol Amiodarone Atrial Fibrillation Efficacy Trial (SAFE-T) Investigators. Amiodarone versus sotalol for atrial fibrillation. N Engl J Med. 2005;352(18):1861–72. doi:.https://doi.org/10.1056/NEJMoa041705
  80. Letelier LM, Udol K, Ena J, Weaver B, Guyatt GH. Effectiveness of amiodarone for conversion of atrial fibrillation to sinus rhythm: a meta-analysis. Arch Intern Med. 2003;163(7):777–85. doi:.https://doi.org/10.1001/archinte.163.7.777
  81. Chevalier P, Durand-Dubief A, Burri H, Cucherat M, Kirkorian G, Touboul P. Amiodarone versus placebo and class Ic drugs for cardioversion of recent-onset atrial fibrillation: a meta-analysis. J Am Coll Cardiol. 2003;41(2):255–62. doi:.https://doi.org/10.1016/S0735-1097(02)02705-5
  82. Goldschlager N, Epstein AE, Naccarelli GV, Olshansky B, Singh B, Collard HR, et al.; Practice Guidelines Sub-committee, North American Society of Pacing and Electrophysiology (HRS). A practical guide for clinicians who treat patients with amiodarone: 2007. Heart Rhythm. 2007;4(9):1250–9. doi:.https://doi.org/10.1016/j.hrthm.2007.07.020
  83. Vorperian VR, Havighurst TC, Miller S, January CT. Adverse effects of low dose amiodarone: a meta-analysis. J Am Coll Cardiol. 1997;30(3):791–8. doi:.https://doi.org/10.1016/S0735-1097(97)00220-9
  84. Crijns HJ, Weijs B, Fairley AM, Lewalter T, Maggioni AP, Martín A, et al. Contemporary real life cardioversion of atrial fibrillation: Results from the multinational RHYTHM-AF study. Int J Cardiol. 2014;172(3):588–94. doi:.https://doi.org/10.1016/j.ijcard.2014.01.099
  85. del Arco C, Martín A, Laguna P, Gargantilla P ; Investigators in the Spanish Atrial Fibrillation in Emergency Medicine Study Group (GEFAUR). Analysis of current management of atrial fibrillation in the acute setting: GEFAUR-1 study. Ann Emerg Med. 2005;46(5):424–30. doi:.https://doi.org/10.1016/j.annemergmed.2005.03.002
  86. Al-Khatib SM, Allen LaPointe NM, Chatterjee R, Crowley MJ, Dupre ME, Kong DF, et al. Rate- and rhythm-control therapies in patients with atrial fibrillation: a systematic review. Ann Intern Med. 2014;160(11):760–73. doi:.https://doi.org/10.7326/M13-1467
  87. Kirchhof P, Andresen D, Bosch R, Borggrefe M, Meinertz T, Parade U, et al. Short-term versus long-term antiarrhythmic drug treatment after cardioversion of atrial fibrillation (Flec-SL): a prospective, randomised, open-label, blinded endpoint assessment trial. Lancet. 2012;380(9838):238–46. doi:.https://doi.org/10.1016/S0140-6736(12)60570-4
  88. Alboni P, Botto GL, Baldi N, Luzi M, Russo V, Gianfranchi L, et al. Outpatient treatment of recent-onset atrial fibrillation with the “pill-in-the-pocket” approach. N Engl J Med. 2004;351(23):2384–91. doi:.https://doi.org/10.1056/NEJMoa041233
  89. Airaksinen KE, Grönberg T, Nuotio I, Nikkinen M, Ylitalo A, Biancari F, et al. Thromboembolic complications after cardioversion of acute atrial fibrillation: the FinCV (Finnish CardioVersion) study. J Am Coll Cardiol. 2013;62(13):1187–92. doi:.https://doi.org/10.1016/j.jacc.2013.04.089
  90. Hansen ML, Jepsen RM, Olesen JB, Ruwald MH, Karasoy D, Gislason GH, et al. Thromboembolic risk in 16 274 atrial fibrillation patients undergoing direct current cardioversion with and without oral anticoagulant therapy. Europace. 2015;17(1):18–23. doi:.https://doi.org/10.1093/europace/euu189
  91. Weigner MJ, Caulfield TA, Danias PG, Silverman DI, Manning WJ. Risk for clinical thromboembolism associated with conversion to sinus rhythm in patients with atrial fibrillation lasting less than 48 hours. Ann Intern Med. 1997;126(8):615–20. doi:.https://doi.org/10.7326/0003-4819-126-8-199704150-00005
  92. Mont L, Bisbal F, Hernández-Madrid A, Pérez-Castellano N, Viñolas X, Arenal A, et al.; SARA investigators. Catheter ablation vs. antiarrhythmic drug treatment of persistent atrial fibrillation: a multicentre, randomized, controlled trial (SARA study). Eur Heart J. 2014;35(8):501–7. doi:.https://doi.org/10.1093/eurheartj/eht457
  93. Wazni OM, Marrouche NF, Martin DO, Verma A, Bhargava M, Saliba W, et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial. JAMA. 2005;293(21):2634–40. doi:.https://doi.org/10.1001/jama.293.21.2634
  94. Oral H, Pappone C, Chugh A, Good E, Bogun F, Pelosi F, Jr, et al. Circumferential pulmonary-vein ablation for chronic atrial fibrillation. N Engl J Med. 2006;354(9):934–41. doi:.https://doi.org/10.1056/NEJMoa050955
  95. Stabile G, Bertaglia E, Senatore G, De Simone A, Zoppo F, Donnici G, et al. Catheter ablation treatment in patients with drug-refractory atrial fibrillation: a prospective, multi-centre, randomized, controlled study (Catheter Ablation For The Cure Of Atrial Fibrillation Study). Eur Heart J. 2006;27(2):216–21. doi:.https://doi.org/10.1093/eurheartj/ehi583
  96. Nyong J, Amit G, Adler AJ, Owolabi OO, Perel P, Prieto-Merino D, et al. Efficacy and safety of ablation for people with non-paroxysmal atrial fibrillation. Cochrane Database Syst Rev. 2016;11:CD012088. doi:.https://doi.org/10.1002/14651858.CD012088.pub2
  97. Calkins H, Reynolds MR, Spector P, Sondhi M, Xu Y, Martin A, et al. Treatment of atrial fibrillation with antiarrhythmic drugs or radiofrequency ablation: two systematic literature reviews and meta-analyses. Circ Arrhythm Electrophysiol. 2009;2(4):349–61. doi:.https://doi.org/10.1161/CIRCEP.108.824789
  98. Duytschaever M, De Pooter J, Demolder A, El Haddad M, Phlips T, Strisciuglio T, et al. Long-term impact of catheter ablation on arrhythmia burden in low-risk patients with paroxysmal atrial fibrillation: The CLOSE to CURE study. Heart Rhythm. 2019;S1547-5271(19)30997-X. doi:.https://doi.org/10.1016/j.hrthm.2019.11.004
  99. Kühne M, Suter Y, Altmann D, Ammann P, Schaer B, Osswald S, et al. Cryoballoon versus radiofrequency catheter ablation of paroxysmal atrial fibrillation: biomarkers of myocardial injury, recurrence rates, and pulmonary vein reconnection patterns. Heart Rhythm. 2010;7(12):1770–6. doi:.https://doi.org/10.1016/j.hrthm.2010.08.028
  100. Kühne M, Knecht S, Altmann D, Ammann P, Schaer B, Osswald S, et al. Validation of a novel spiral mapping catheter for real-time recordings from the pulmonary veins during cryoballoon ablation of atrial fibrillation. Heart Rhythm. 2013;10(2):241–6. doi:.https://doi.org/10.1016/j.hrthm.2012.10.009
  101. Pavlović N, Sticherling C, Knecht S, Reichlin T, Mühl A, Schaer B, et al. One-year follow-up after irrigated multi-electrode radiofrequency ablation of persistent atrial fibrillation. Europace. 2016;18(1):85–91. doi:.https://doi.org/10.1093/europace/euv020
  102. Dagres N, Hindricks G, Kottkamp H, Sommer P, Gaspar T, Bode K, et al. Complications of atrial fibrillation ablation in a high-volume center in 1,000 procedures: still cause for concern? J Cardiovasc Electrophysiol. 2009;20(9):1014–9. doi:.https://doi.org/10.1111/j.1540-8167.2009.01493.x
  103. Deshmukh A, Patel NJ, Pant S, Shah N, Chothani A, Mehta K, et al. In-hospital complications associated with catheter ablation of atrial fibrillation in the United States between 2000 and 2010: analysis of 93 801 procedures. Circulation. 2013;128(19):2104–12. doi:.https://doi.org/10.1161/CIRCULATIONAHA.113.003862
  104. Zuern CS, Kilias A, Berlitz P, Seizer P, Gramlich M, Müller K, et al. Anticoagulation after catheter ablation of atrial fibrillation guided by implantable cardiac monitors. Pacing Clin Electrophysiol. 2015;38(6):688–93. doi:.https://doi.org/10.1111/pace.12625
  105. Middlekauff HR, Stevenson WG, Stevenson LW. Prognostic significance of atrial fibrillation in advanced heart failure. A study of 390 patients. Circulation. 1991;84(1):40–8. doi:.https://doi.org/10.1161/01.CIR.84.1.40
  106. Mahoney P, Kimmel S, DeNofrio D, Wahl P, Loh E. Prognostic significance of atrial fibrillation in patients at a tertiary medical center referred for heart transplantation because of severe heart failure. Am J Cardiol. 1999;83(11):1544–7. doi:.https://doi.org/10.1016/S0002-9149(99)00144-7
  107. Senni M, Tribouilloy CM, Rodeheffer RJ, Jacobsen SJ, Evans JM, Bailey KR, et al. Congestive heart failure in the community: a study of all incident cases in Olmsted County, Minnesota, in 1991. Circulation. 1998;98(21):2282–9. doi:.https://doi.org/10.1161/01.CIR.98.21.2282
  108. Maisel WH, Stevenson LW. Atrial fibrillation in heart failure: epidemiology, pathophysiology, and rationale for therapy. Am J Cardiol. 2003;91(6):2–8. doi:.https://doi.org/10.1016/S0002-9149(02)03373-8
  109. Vermes E, Tardif JC, Bourassa MG, Racine N, Levesque S, White M, et al. Enalapril decreases the incidence of atrial fibrillation in patients with left ventricular dysfunction: insight from the Studies Of Left Ventricular Dysfunction (SOLVD) trials. Circulation. 2003;107(23):2926–31. doi:.https://doi.org/10.1161/01.CIR.0000072793.81076.D4
  110. Ducharme A, Swedberg K, Pfeffer MA, Cohen-Solal A, Granger CB, Maggioni AP, et al.; CHARM Investigators. Prevention of atrial fibrillation in patients with symptomatic chronic heart failure by candesartan in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program. Am Heart J. 2006;152(1):86–92. doi:.https://doi.org/10.1016/j.ahj.2005.06.036
  111. Nasr IA, Bouzamondo A, Hulot JS, Dubourg O, Le Heuzey JY, Lechat P. Prevention of atrial fibrillation onset by beta-blocker treatment in heart failure: a meta-analysis. Eur Heart J. 2007;28(4):457–62. doi:.https://doi.org/10.1093/eurheartj/ehl484
  112. Swedberg K, Zannad F, McMurray JJ, Krum H, van Veldhuisen DJ, Shi H, et al.; EMPHASIS-HF Study Investigators. Eplerenone and atrial fibrillation in mild systolic heart failure: results from the EMPHASIS-HF (Eplerenone in Mild Patients Hospitalization And SurvIval Study in Heart Failure) study. J Am Coll Cardiol. 2012;59(18):1598–603. doi:.https://doi.org/10.1016/j.jacc.2011.11.063
  113. Van Gelder IC, Crijns HJ, Blanksma PK, Landsman ML, Posma JL, Van Den Berg MP, et al. Time course of hemodynamic changes and improvement of exercise tolerance after cardioversion of chronic atrial fibrillation unassociated with cardiac valve disease. Am J Cardiol. 1993;72(7):560–6. doi:.https://doi.org/10.1016/0002-9149(93)90352-D
  114. Zipes DP. Atrial fibrillation. A tachycardia-induced atrial cardiomyopathy. Circulation. 1997;95(3):562–4. doi:.https://doi.org/10.1161/01.CIR.95.3.562
  115. Wilson JR, Douglas P, Hickey WF, Lanoce V, Ferraro N, Muhammad A, et al. Experimental congestive heart failure produced by rapid ventricular pacing in the dog: cardiac effects. Circulation. 1987;75(4):857–67. doi:.https://doi.org/10.1161/01.CIR.75.4.857
  116. Marrouche NF, Brachmann J, Andresen D, Siebels J, Boersma L, Jordaens L, et al.; CASTLE-AF Investigators. Catheter Ablation for Atrial Fibrillation with Heart Failure. N Engl J Med. 2018;378(5):417–27. doi:.https://doi.org/10.1056/NEJMoa1707855
  117. Jones DG, Haldar SK, Hussain W, Sharma R, Francis DP, Rahman-Haley SL, et al. A randomized trial to assess catheter ablation versus rate control in the management of persistent atrial fibrillation in heart failure. J Am Coll Cardiol. 2013;61(18):1894–903. doi:.https://doi.org/10.1016/j.jacc.2013.01.069
  118. Anselmino M, Matta M, D’Ascenzo F, Bunch TJ, Schilling RJ, Hunter RJ, et al. Catheter ablation of atrial fibrillation in patients with left ventricular systolic dysfunction: a systematic review and meta-analysis. Circ Arrhythm Electrophysiol. 2014;7(6):1011–8. doi:.https://doi.org/10.1161/CIRCEP.114.001938
  119. Khan MN, Jaïs P, Cummings J, Di Biase L, Sanders P, Martin DO, et al.; PABA-CHF Investigators. Pulmonary-vein isolation for atrial fibrillation in patients with heart failure. N Engl J Med. 2008;359(17):1778–85. doi:.https://doi.org/10.1056/NEJMoa0708234
  120. Kraft E, Marti M, Werner S, Sommer H. Cost of dementia in Switzerland. Swiss Med Wkly. 2010;140:w13093.
  121. Kwok CS, Loke YK, Hale R, Potter JF, Myint PK. Atrial fibrillation and incidence of dementia: a systematic review and meta-analysis. Neurology. 2011;76(10):914–22. doi:.https://doi.org/10.1212/WNL.0b013e31820f2e38
  122. Thacker EL, McKnight B, Psaty BM, Longstreth WT, Jr, Sitlani CM, Dublin S, et al. Atrial fibrillation and cognitive decline: a longitudinal cohort study. Neurology. 2013;81(2):119–25. doi:.https://doi.org/10.1212/WNL.0b013e31829a33d1
  123. Gottesman RF, Albert MS, Alonso A, Coker LH, Coresh J, Davis SM, et al. Associations Between Midlife Vascular Risk Factors and 25-Year Incident Dementia in the Atherosclerosis Risk in Communities (ARIC) Cohort. JAMA Neurol. 2017;74(10):1246–54. doi:.https://doi.org/10.1001/jamaneurol.2017.1658
  124. Vermeer SE, Koudstaal PJ, Oudkerk M, Hofman A, Breteler MM. Prevalence and risk factors of silent brain infarcts in the population-based Rotterdam Scan Study. Stroke. 2002;33(1):21–5. doi:.https://doi.org/10.1161/hs0102.101629
  125. Vermeer SE, Prins ND, den Heijer T, Hofman A, Koudstaal PJ, Breteler MM. Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med. 2003;348(13):1215–22. doi:.https://doi.org/10.1056/NEJMoa022066
  126. Conen D, Rodondi N, Mueller A, Beer J, Auricchio A, Ammann P, et al. Design of the Swiss Atrial Fibrillation Cohort Study (Swiss-AF): structural brain damage and cognitive decline among patients with atrial fibrillation. Swiss Med Wkly. 2017;147:w14467. doi:.https://doi.org/10.4414/smw.2017.14467
  127. Conen D, Rodondi N, Müller A, Beer JH, Ammann P, Moschovitis G, et al.; Swiss-AF Study Investigators. Relationships of Overt and Silent Brain Lesions With Cognitive Function in Patients With Atrial Fibrillation. J Am Coll Cardiol. 2019;73(9):989–99. doi:.https://doi.org/10.1016/j.jacc.2018.12.039

Most read articles by the same author(s)

1 2 > >>