Is there a need to treat atrial fibrillation aggressively?

Czech version

Authors: Josef Kautzner
Authors‘ workplace: Klinika kardiologie IKEM Praha, přednosta prof. MUDr. Josef Kautzner, CSc.
Published in: Vnitř Lék 2015; 61(5): 417-420
Category: Reviews

Overview

Atrial fibrillation (AF) is the most frequent sustained arrhythmia in human. Earlier studies comparing strategy of rhythm control versus rate control did not show any difference in outcomes. This resulted in conservative approach when managing less symptomatic AF. This situation is changing in last years. One of the reasons is emerging data on higher risk of AF for human health, especially on consequences of asymptomatic brain embolisations and AF-related brain hypoperfusion. These may explain association of AF with dementia. The other reason reflects more encouraging results of catheter ablation of AF. These factors provide new insight into indications for interventional therapy of this arrhythmia. In the same time, they justify efforts for maintenance of sinus rhythm, even at the expense of repeated intervention or combined therapy with previously ineffective drugs.

Key words:
asymptomatic brain embolizations – atrial fibrillation – catheter ablation – dementia

Sources

1. Heeringa J, van der Kuip DA, Hofman A et al. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J 2006; 27(8): 949–953.

2. Caldeira D, David C, Sampaio C. Rate versus rhythm control in atrial fibrillation and clinical outcomes: Updated systematic review and meta-analysis of randomized controlled trials. Arch Cardiovasc Dis 2012; 105(4): 226–238.

3. Van Gelder IC, Wyse DG, Chandler ML et al. Does intensity of rate-control influence outcome in atrial fibrillation? An analysis of pooled data from the RACE and AFFIRM studies. Europace 2006; 8(11): 935–942.

4. Marshall DA, Levy AR, Vidaillet H et al. Cost-effectiveness of rhythm versus rate control in atrial fibrillation. Ann Intern Med 2004; 141(9): 653–661.

5. Mason PK, Wood MA, Lake D et al. Influence of the randomized trials, AFFIRM and RACE, on the management of atrial fibrillation in two University Medical Centers. Am J Cardiol 2005; 95(10): 1248–1250.

6. Corley SD, Epstein AE, DiMarco JP et al. Relationships between sinus rhythm, treatment, and survival in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Study. Circulation 2004; 109(12): 1509–1513.

7. Guglin M, Chen R, Curtis AB. Sinus rhythm is associated with fewer heart failure symptoms: insights from the AFFIRM trial. Heart Rhythm 2010; 7(5): 596–601.

8. Vidaillet H, Granada JF, Chyou PH et al. A population-based study of mortality among patients with atrial fibrillation or flutter. Am J Med 2002; 113(5): 365–370.

9. Dulli DA, Stanko H, Levine RL. Atrial fibrillation is associated with severe acute ischemic stroke. Neuroepidemiology 2003; 22(2): 118–123.

10. Waldo AL. Anticoagulation: stroke prevention in patients with atrial fibrillation. Med Clin North Am 2008; 92(1): 143–159.

11. Verma A, Debruyne P, Nardi S et al. ERACE Investigators. Evaluation and reduction of asymptomatic cerebral embolism in ablation of atrial fibrillation, but high prevalence of chronic silent infarction: results of the evaluation of reduction of asymptomatic cerebral embolism trial. Circ Arrhythm Electrophysiol 2013; 6(5): 835–842.

12. Sramko M, Peichl P, Wichterle D et al. A novel biomarker-based approach for the detection of asymptomatic brain injury during catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2014; 25(4): 349–354.

13. Santangeli P, Di Biase L, Bai R et al. Atrial fibrillation and the risk of incident dementia: a meta-analysis. Heart Rhythm 2012; 9(11): 1761–1768.

14. Stefansdottir H, Arnar DO, Aspelund T et al. Atrial fibrillation is associated with reduced brain volume and cognitive function independent of cerebral infarcts. Stroke 2013; 44(4): 1020–1025.

15. Efimova I, Efimova N, Chernov V et al. Ablation and pacing: improving brain perfusion and cognitive function in patients with atrial fibrillation and uncontrolled ventricular rates. Pacing Clin Electrophysiol 2012; 35(3): 320–326.

16. de la Torre JC. Cardiovascular risk factors promote brain hypoperfusion leading to cognitive decline and dementia. Cardiovasc Psychiatry Neurol 2012; 2012: 367516. Dostupné z DOI: <http://dx.doi.org/10.1155/2012/367516>.

17. Lishmanov A, Chockalingam P, Senthilkumar A et al. Tachycardia-induced cardiomyopathy: evaluation and therapeutic options. Congest Heart Fail 2010; 16(3): 122–126.

18. Gupta S, Figueredo VM. Tachycardia mediated cardiomyopathy: pathophysiology, mechanisms, clinical features and management. Int J Cardiol 2014; 172(1): 40–46.

19. Maisel WH, Stevenson LW. Atrial fibrillation in heart failure: epidemiology, pathophysiology, and rationale for therapy. Am J Cardiol 2003; 91(6A): 2D-8D.

20. Bardai A, Blom MT, van Hoeijen DA et al. Atrial fibrillation is an independent risk factor for ventricular fibrillation: a large-scale population-based case-control study. Circ Arrhythm Electrophysiol 2014; 7(6): 1033–1039.

21. Reinier K, Marijon E, Uy-Evanado A et al. The association between atrial fibrillation and sudden cardiac death: the relevance of heart failure. JACC Heart Fail 2014; 2(3): 221–227.

22. Calkins H, Reynolds MR, Spector P 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): 349–361.

23. Camm AJ, Lip GY, De Caterina R et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 2012; 33(21): 2719–2747.

24. Calkins H, Kuck KH, Cappato R et al. 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace 2012; 14(10): 528–606.

25. Sramko M, Peichl P, Wichterle D et al. Clinical value of assessment of left atrial late gadolinium enhancement in patients undergoing ablation of atrial fibrillation. Int J Cardiol 2015; 179: 351–357.

26. Hussein AA, Saliba WI, Martin DO et al. Natural history and long-term outcomes of ablated atrial fibrillation. Circ Arrhythm Electrophysiol 2011; 4(3): 271–278.

27. Deshmukh A, Patel NJ, Pant S 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): 2104–2112.

28. Aldhoon B, Wichterle D, Peichl P et al. Complications of catheter ablation for atrial fibrillation in a high-volume centre with the use of intracardiac echocardiography. Europace 2013; 15(1): 24–32.