[Atrial fibrillation].
BACKGROUND
About 800,000 patients in Germany suffer from atrial fibrillation. The incidence increases by the factor 10 with increasing age. Among people > or = 85 years 35 new cases per 1,000 occur every year. Atrial fibrillation is associated with an increased mortality.


METHODS
Atrial fibrillation is classified according to criteria of time: acute, paroxysmal, persistent, or permanent. On this basis this is essential for decisions about the optimal time for cardioversion and especially with respect to duration of anticoagulation before and after the intervention. A classification according to concomitant diseases (risk factors for thromboembolic complications) defines patients who should receive an oral anticoagulation.


METHODS
Patients with lone (idiopathic) atrial fibrillation 60 years of age do not need oral anticoagulation. A cardioversion with class I antiarrhythmic drugs can only be considered for patients with acute atrial fibrillation without further heart diseases. For prophylaxis after cardioversion amiodarone with its high efficiency and its low proarrhythmic risk is the first choice. Still, this has to be done with caution and regarding the various extracardial side effects. For all procedures to restore sinus rhythm it has to be kept in mind that there is no evidence yet that they improve the prognosis. Therefore, the concept of frequency control under long-term anticoagulation is more and more favored.


RESULTS
The most severe complications of atrial fibrillation are thromboembolic diseases, especially strokes. The risk for strokes can be reduced by nearly 70% by oral anticoagulation in patients with non rheumatic atrial fibrillation. The risk of bleeding complications, mostly extracranial, has to be weighed against the primary goal of anticoagulation. Bleeding complications closely correlate with the intensity of anticoagulation. In patients with nonrheumatic atrial fibrillation an INR between 2.0 and 3.0 has found to be effective and safe. Above an INR level of 4.0 the bleeding risk is much higher without an additional protective effect.
Höhler
Helene
H
Kliniken St. Antonius gGmbH, Zentrum für Innere Medizin, Wuppertal.
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000145:classification* / Q000150:complications / Q000401:mortality / Q000628:therapy; D002423:Cause of Death; D004562:Electrocardiography / Q000145:classification; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015996:Survival Rate