From the Guidelines
Atrial Fibrillation (Afib) is a supraventricular tachyarrhythmia characterized by uncoordinated electrical activation of the atria, resulting in dyssynchronous atrial contraction and irregular ventricular excitation.
Definition and Classification
- Afib is the most common sustained cardiac arrhythmia, with a prevalence of 1-2% in the general population, increasing significantly with age 1.
- It is classified into different types, including:
- Paroxysmal AF: episodes that last less than 7 days
- Persistent AF: episodes that last more than 7 days
- Permanent AF: AF that is continuously sustained and cardioversion has failed or not been attempted 1
Causes and Risk Factors
- Afib can occur in apparently healthy individuals, but more than 70% of patients with Afib have underlying structural heart diseases, such as hypertension, left atrial enlargement, coronary artery disease, heart failure, and valvular heart diseases 1.
- Non-cardiac diseases, such as diabetes mellitus, hyperthyroidism, obesity, asthma, obstructive sleep apnea, and chronic kidney disease, can also contribute to the development of Afib 1.
- Acute temporary causes of Afib include excessive alcohol intake, surgery, pericarditis, myocarditis, hyperthyroidism, and pulmonary embolism 1.
Consequences and Management
- Afib is associated with an increased risk of stroke, heart failure, and mortality, as well as significant symptoms and diminished quality of life 1.
- Management of Afib involves a holistic approach, including stroke prevention, addressing symptoms, and risk factor management 1.
- The AF-CARE framework is a comprehensive approach to managing Afib, which includes:
- Comorbidity and risk factor management
- Avoiding stroke and thromboembolism
- Reducing symptoms through rate and rhythm control
- Evaluation and dynamic reassessment 1
From the Research
Definition and Overview of Atrial Fibrillation
- Atrial fibrillation (AF) is an ectopic rhythm originating in the atrium 2.
- It is the most common sustained cardiac arrhythmia in clinical practice, posing a significant burden worldwide due to high rates of morbidity, disability, and mortality 2, 3, 4.
- AF can be symptomatic, with patients experiencing chest pain, palpitations, shortness of breath, and fatigue, or asymptomatic, also known as "silent" AF 3.
Prevalence and Risk Factors
- The prevalence of AF increases significantly with age 4.
- It is linked to serious adverse outcomes, including stroke and other thromboembolic events, heart failure, and other serious conditions 4, 5.
- AF is categorized according to its persistence and duration, and its management includes rhythm and rate control to address symptoms and reduce the risk of complications 4, 6.
Management and Treatment
- Current therapy for AF mainly includes drug therapy, catheter ablation, cryoballoon ablation, left atrial appendage closure, and the maze procedure 2.
- The goal of treatment is to prevent and control AF, with a focus on rate control, rhythm control, and stroke prophylaxis 5.
- Antithrombotic therapy for stroke risk reduction is recommended, with the choice of antithrombotic agent depending on the level of stroke risk 6.