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Abstract
With over 6 million patients affected only in the United States, atrial fibrillation (AF) is a major health problem with profound effects on both the individual patient and society at large. In this issue of Heart Failure Clinics, we have focused on AF and tried to cover the most important and relevant aspects in a comprehensive and contemporary review. A distinguished group of experts and leaders in basic and experimental electrophysiology, epidemiology, clinical pharmacology, interventional clinical electrophysiology, and cardiac surgery contributed state-of-the-art reviews and also shared their insight to the future of AF. Topics include but are not limited to: Risk Factors and Genetics of Atrial Fibrillation; Mechanisms of Atrial Fibrillation: Rotors, Ionic Determinants, and Excitation Frequency; Diagnostic Evaluation and Follow-Up of Patients with Atrial Fibrillation; Catheter Ablation of Atrial Fibrillation; Antithrombotic and Anticoagulant Therapy for Atrial Fibrillation; Postoperative Atrial Fibrillation: Incidence, Mechanisms, and Clinical Correlates; and Novel Upstream Approaches to Prevent Atrial Fibrillation Perpetuation.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Atrial Fibrillation\r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| CONSULTING EDITORS | iii | ||
| EDITOR | iii | ||
| AUTHORS | iii | ||
| Contents | v | ||
| Risk Factors and Genetics of Atrial Fibrillation\r | v | ||
| Mechanisms of Atrial Fibrillation: Rotors, Ionic Determinants, and Excitation Frequency\r | v | ||
| Diagnostic Evaluation and Follow-Up of Patients with Atrial Fibrillation\r | v | ||
| Rate Versus Rhythm Control for Atrial Fibrillation\r | v | ||
| Antiarrhythmic Drug Therapy for Atrial Fibrillation\r | vi | ||
| Catheter Ablation of Atrial Fibrillation\r | vi | ||
| Surgery for Atrial Fibrillation\r | vi | ||
| Atrioventricular Junction Ablation for Atrial Fibrillation\r | vi | ||
| Antithrombotic and Anticoagulant Therapy for Atrial Fibrillation\r | vi | ||
| Left Atrial Appendage Exclusion for Atrial Fibrillation\r | vii | ||
| Postoperative Atrial Fibrillation: Incidence, Mechanisms, and Clinical Correlates\r | vii | ||
| Novel Upstream Approaches to Prevent Atrial Fibrillation Perpetuation\r | vii | ||
| HEART FAILURE CLINICS\r | viii | ||
| FORTHCOMING ISSUES | viii | ||
| July 2016 | viii | ||
| October 2016 | viii | ||
| RECENT ISSUES | viii | ||
| January 2016 | viii | ||
| October 2015 | viii | ||
| Risk Factors and Genetics of Atrial Fibrillation | 157 | ||
| Key points | 157 | ||
| INTRODUCTION | 157 | ||
| AGING | 157 | ||
| HYPERTENSION | 158 | ||
| HEART FAILURE AND CORONARY ARTERY DISEASE | 158 | ||
| PERICARDIAL FAT AND OBESITY | 159 | ||
| SLEEP APNEA | 159 | ||
| ATRIAL DILATATION AND STRETCH | 160 | ||
| OTHER RISK FACTORS | 160 | ||
| GENETIC RISK FACTORS AND AF | 160 | ||
| GENETIC VARIANTS ASSOCIATED WITH AF | 160 | ||
| RARE GENETIC VARIANTS AND AF | 160 | ||
| Ion Channel Genes | 160 | ||
| Non–Ion Channel Genes | 162 | ||
| COMMON GENETIC VARIANTS AND AF | 162 | ||
| REFERENCES | 163 | ||
| Mechanisms of Atrial Fibrillation | 167 | ||
| Key points | 167 | ||
| INTRODUCTION | 167 | ||
| FREQUENCY-DEPENDENT BREAKDOWN OF WAVE PROPAGATION | 168 | ||
| Relationship Between the Dynamic Patterns of Rotors and DFs | 170 | ||
| TRANSITION FROM PAROXYSMAL TO PEAF IS REFLECTED BY DF CHANGES | 170 | ||
| The Rate of DF Increase Predicts the Onset of PeAF | 171 | ||
| Electrophysiologic Remodeling in Ionic Currents and DF Increase | 172 | ||
| TRANSLATION TO PATIENTS: THE HIGH DF SITES AND MAINTENANCE OF AF | 173 | ||
| DF Mapping in Patients to Guide AF Ablation | 174 | ||
| SUMMARY | 174 | ||
| REFERENCES | 176 | ||
| Diagnostic Evaluation and Follow-Up of Patients with Atrial Fibrillation | 179 | ||
| Key points | 179 | ||
| INTRODUCTION | 179 | ||
| DIAGNOSTIC EVALUATION | 179 | ||
| Clinical History | 179 | ||
| Symptoms | 179 | ||
| Quality of life | 180 | ||
| Past medical history | 182 | ||
| Medications | 183 | ||
| PHYSICAL EXAMINATION | 183 | ||
| Diagnostics | 183 | ||
| FOLLOW-UP | 184 | ||
| Anticoagulation | 184 | ||
| Antiarrhythmic Therapy | 184 | ||
| Radiofrequency Ablation | 187 | ||
| REFERENCES | 187 | ||
| Rate Versus Rhythm Control for Atrial Fibrillation | 193 | ||
| Key points | 193 | ||
| DRUG THERAPY FOR MAINTENANCE OF SINUS RHYTHM | 193 | ||
| RATE CONTROL IN AF | 195 | ||
| RATE VERSUS RHYTHM CONTROL | 195 | ||
| CATHETER ABLATION VERSUS AAD’S | 197 | ||
| CATHETER ABLATION AS FIRST-LINE TREATMENT | 198 | ||
| CATHETER ABLATION OF AF | 201 | ||
| SUMMARY | 201 | ||
| REFERENCES | 201 | ||
| Antiarrhythmic Drug Therapy for Atrial Fibrillation | 205 | ||
| Key points | 205 | ||
| RHYTHM VERSUS RATE CONTROL | 206 | ||
| RHYTHM CONTROL | 206 | ||
| Pharmacologic Cardioversion | 206 | ||
| Decision to Maintain Sinus Rhythm | 207 | ||
| Available AAD Choices | 207 | ||
| Quinidine | 207 | ||
| Disopyramide | 207 | ||
| Flecainide and propafenone | 207 | ||
| Sotalol | 208 | ||
| Dofetilide | 208 | ||
| Amiodarone | 209 | ||
| Dronedarone | 209 | ||
| Ibutilide | 210 | ||
| Common Rules in AAD Selection | 210 | ||
| OUTPATIENT VERSUS INPATIENT START OF ANTIARRHYTHMIC THERAPY | 211 | ||
| UPSTREAM THERAPY FOR AF | 211 | ||
| Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers | 214 | ||
| 3-Hydroxy-3-Methylglutaryl–Coenzyme A Reductase Inhibitors/Statins | 214 | ||
| Antiinflammatory Agents | 215 | ||
| Aldosterone Antagonists | 215 | ||
| FUTURE PHARMACOLOGIC THERAPY | 215 | ||
| Vernakalant | 216 | ||
| Ranolazine | 216 | ||
| Miscellaneous | 216 | ||
| SUMMARY | 216 | ||
| REFERENCES | 216 | ||
| Catheter Ablation of Atrial Fibrillation | 223 | ||
| Key points | 223 | ||
| INTRODUCTION | 223 | ||
| PREOPERATIVE PLANNING | 223 | ||
| Patient Selection | 223 | ||
| Preprocedure Testing | 223 | ||
| Anticoagulation | 224 | ||
| ABLATION STRATEGY | 224 | ||
| AF Mechanisms | 224 | ||
| PVI | 224 | ||
| Additional Strategies | 225 | ||
| Cryoballoon Catheter | 226 | ||
| POSTPROCEDURE CARE AND FOLLOW-UP | 226 | ||
| ABLATION OUTCOMES | 227 | ||
| Procedural Success | 227 | ||
| Stroke Benefit | 228 | ||
| Mortality Benefit | 230 | ||
| Complications | 230 | ||
| SUMMARY | 230 | ||
| REFERENCES | 231 | ||
| Surgery for Atrial Fibrillation | 235 | ||
| Key points | 235 | ||
| INTRODUCTION | 235 | ||
| INDICATIONS FOR SURGICAL ABLATION OF ATRIAL FIBRILLATION | 236 | ||
| SURGICAL TECHNIQUE: COX-MAZE IV PROCEDURE | 236 | ||
| Preoperative Planning | 236 | ||
| Positioning | 236 | ||
| Operative Technique | 236 | ||
| Sternotomy approach | 236 | ||
| Pulmonary Vein Isolation | 238 | ||
| Right Atrial Lesion Set | 238 | ||
| Left Atrial Lesion Set | 239 | ||
| Right mini-thoracotomy approach | 239 | ||
| PERIOPERATIVE AND POSTOPERATIVE MANAGEMENT | 240 | ||
| SURGICAL RESULTS: CMPIV | 240 | ||
| SUMMARY | 241 | ||
| REFERENCES | 241 | ||
| Atrioventricular Junction Ablation for Atrial Fibrillation | 245 | ||
| Key points | 245 | ||
| INTRODUCTION | 245 | ||
| INDICATIONS FOR AVJ ABLATION | 246 | ||
| Refractory AF/Atrial Flutter and Rapid Ventricular Rates | 246 | ||
| AF and Cardiac Resynchronization Therapy | 246 | ||
| AVJ ABLATION PROCEDURE | 246 | ||
| COMPLICATIONS | 247 | ||
| HEMODYNAMICS OF AVJ ABLATION | 248 | ||
| TACHYCARDIA-INDUCED CARDIOMYOPATHY | 248 | ||
| DEVICE SELECTION AFTER AVJ ABLATION | 249 | ||
| LONG-TERM OUTCOMES AFTER AVJ ABLATION | 251 | ||
| ALTERNATIVES | 251 | ||
| NEW TECHNOLOGY | 252 | ||
| SUMMARY | 253 | ||
| REFERENCES | 253 | ||
| Antithrombotic and Anticoagulant Therapy for Atrial Fibrillation | 257 | ||
| Key points | 257 | ||
| INTRODUCTION | 257 | ||
| ASSESSMENT OF STROKE AND BLEEDING RISK | 258 | ||
| ANTICOAGULATION THERAPY | 259 | ||
| Vitamin K Antagonists (eg, Warfarin) | 259 | ||
| Non-VKA Oral Anticoagulants | 262 | ||
| ANTITHROMBOTIC THERAPY | 265 | ||
| ANTIPLATELET AGENTS IN AF PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION/STENTING | 266 | ||
| PREVENTION OF NONPHARMACOLOGIC STROKE AND THROMBOEMBOLISM | 267 | ||
| SUMMARY | 268 | ||
| REFERENCES | 268 | ||
| Left Atrial Appendage Exclusion for Atrial Fibrillation | 273 | ||
| Key points | 273 | ||
| INTRODUCTION | 273 | ||
| LAA STRUCTURE AND FUNCTION | 274 | ||
| Morphology | 274 | ||
| Regional Anatomy | 275 | ||
| Morphologic Variation | 275 | ||
| Function | 276 | ||
| STROKE MECHANISMS IN ATRIAL FIBRILLATION | 276 | ||
| Systemic Factors, Clinical Risk Prediction, and Ventricular-Vascular Interactions | 276 | ||
| LAA Dysfunction and Myopathy | 277 | ||
| LAA Morphology and Microstructure Complexity | 278 | ||
| LAA CLOSURE FOR CARDIOEMBOLIC RISK REDUCTION | 278 | ||
| Surgical Approaches | 278 | ||
| Minimally Invasive and Hybrid Surgical Approaches | 279 | ||
| Percutaneous LAA Closure | 279 | ||
| TRANSSEPTAL APPROACH | 279 | ||
| Percutaneous Left Atrial Appendage Transcatheter Occlusion | 279 | ||
| ACP | 279 | ||
| WATCHMAN | 281 | ||
| WaveCrest | 283 | ||
| Other Transeptal Devices | 283 | ||
| EPICARDIAL APPROACH | 284 | ||
| HYBRID APPROACH | 285 | ||
| PREVENTION AND MANAGEMENT OF COMPLICATIONS | 286 | ||
| UNANSWERED QUESTIONS | 287 | ||
| SUMMARY | 290 | ||
| REFERENCES | 290 | ||
| Postoperative Atrial Fibrillation | 299 | ||
| Key points | 299 | ||
| INTRODUCTION | 299 | ||
| MECHANISM | 299 | ||
| EPIDEMIOLOGY | 300 | ||
| PROGNOSIS | 301 | ||
| MANAGEMENT GOALS | 301 | ||
| PHARMACOLOGIC STRATEGIES | 301 | ||
| β-Blockers | 301 | ||
| Antiarrhythmic Drugs | 302 | ||
| Amiodarone | 302 | ||
| Sotalol | 302 | ||
| Ibutilide and dofetilide | 302 | ||
| Class I AADs | 302 | ||
| Calcium Channel Blockers and Digoxin | 302 | ||
| Magnesium | 302 | ||
| Miscellaneous Agents | 302 | ||
| NONPHARMACOLOGIC STRATEGIES | 302 | ||
| Prophylactic Atrial Pacing | 302 | ||
| Electrical Cardioversion | 303 | ||
| Posterior Pericardiotomy | 303 | ||
| Anterior Fat Pad Preservation | 303 | ||
| ANTICOAGULATION | 303 | ||
| RECURRENCE | 304 | ||
| SUMMARY | 304 | ||
| REFERENCES | 304 | ||
| Novel Upstream Approaches to Prevent Atrial Fibrillation Perpetuation | 309 | ||
| Key points | 309 | ||
| THE EPIDEMIC OF ATRIAL FIBRILLATION | 309 | ||
| A NEW ANIMAL MODEL OF PERSISTENT AF | 310 | ||
| SUSTAINED HIGH-FREQUENCY ATRIAL EXCITATION RESULTS IN OXIDATIVE STRESS | 311 | ||
| ROLE OF INFLAMMATION | 313 | ||
| THE RAAS AND ATRIAL FIBROSIS | 314 | ||
| IS GAL-3 A NEW PLAYER IN AF REMODELING? | 316 | ||
| OUTLOOK ON PREVENTATIVE AF THERAPY | 318 | ||
| ACKNOWLEDGMENTS | 318 | ||
| REFERENCES | 318 |