Atrial fibrillation: preventing thromboembolism and choosing nondrug therapies.
A major consequence of atrial fibrillation (AF) is stroke. For stroke prevention in AF, the American Heart Association recommends aspirin, 325 mg/d, for low-risk patients. For all others, anticoagulation with warfarin to a target INR of 2 to 3 is recommended if warfarin is not contraindicated. Approximately 0.3% of patients receiving warfarin suffer intracranial hemorrhage. For restoration of sinus rhythm in recent AF, direct current cardioversion is the treatment of choice if a trial of antiarrhythmic drug therapy has failed or is contraindicated. Potential complications include thromboembolism, ventricular arrhythmia, and pulmonary edema. Permanent pacemakers can be used to control conduction disturbances such as sick sinus syndrome and to prevent paroxysmal AF. Radiofrequency AV nodal ablation provides symptomatic relief for some patients with chronic or paroxysmal AF. Surgical techniques are also being developed for AF. These include left atrial isolation and the corridor and maze procedures.
Department of medicine, Albert Einstein Medical Center, Philadelphia, USA.
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Chandramouli
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Kotler
D000368:Aged; D000465:Algorithms; D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000150:complications* / Q000628:therapy*; D017115:Catheter Ablation; D000075202:Contraindications; D003663:Decision Trees; D004554:Electric Countershock; D006801:Humans; D010138:Pacemaker, Artificial; D018579:Patient Selection; D012307:Risk Factors; D013923:Thromboembolism / Q000209:etiology* / Q000517:prevention & control*
D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants