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Posted By: Judah98 Friedman98 | Posted On: 2008-04-07 | Article ID: 51702

Updates in the treatment of Atrial Fibrillation

Atrial Fibrillation (AF) or afib as it is popularly known is an abnormal rhythm in the beating of the heart (Cardiac arrhythmia), which involves the two atria of the heart. Atrial Fibrillation can be generally identified while noting a pulse. AF is the commonest arrhythmia and the risk of contacting it increases with age. Though it is not life threatening in itself, it may lead to further complications like chest pain, fainting, congestive heart failure. AF is the leading cause of heart stroke now. Left unattended and without medication, Atrial fibrillation may lead to a chronic condition leading to a stroke and then to death. Stroke risk increases 5 times with AF, and the frequency of AF is over 10% for those above 80 years of age. Over 2 million people in the United States have AF.

The first sign of an Atrial Fibrillation is the irregular beat in the heart, sometimes fast. The disorganized activity in the two atria can be seen on the Electrocardiogram (ECG) as rapid waves of unstable size and shape rather than the classic P waves. AF causes continuous electrical activity to spread across the atria, causing it to fibrillate at 300 to 600 BPM. This irregularity is then transferred to the ventricles that produce the heart beat and the outcome is the irregular rhythm. AF can be persistent AF(or permanent) or paroxysmal AF (occurring alternately between normal heart beats). Although the prevalence of AF is higher in men, the mortality rate is higher in women. Patients with AF have higher rates of hypertension, valve and coronary artery diseases, sinus node dysfunction, and thyroid diseases.

Patients with AF have many pharmacologic options to choose from for the rhythm control. Many new methods have been discovered recently and might be used in conjunction with the existing ones which can be more effective in the treatment of AF. Recently, AF was found to be associated with C-reactive protein (CRP) which is a blood marker of inflammation. Although the cause of CRP in AF is unknown, inflammation based atrial remodeling might be the underlying cause. Mostly in patients with non-symptomatic paroxysmal AF or self-terminating AF, Anticoagulation with a tablet of aspirin may be enough. For some of them, either electrical cardioversion or anti arrhythmic drugs may be necessary for rapid restoration of normal sinus rhythm. It is highly recommended for paroxysmal AF, myocardinal infarction or symptomatic hypotension, angina or heart failure.

The better option today for the arrhythmia is the rate and rhythm control. It is because the antiarrhythmic drugs are only 60% effective in the long-run and also carry other side effects. Rate control involves Calcium channel blockers (CCBs), Digoxin, AV node ablation. Recent studies have shown the effectiveness of these rate and rhythm control methods in reducing the occurrence and reoccurrence and decreasing the mortality rate in AF. The largest study was the Atrial Fibrillation follow-up investigation of rhythm management (AFFIRM). The debate still continues over the rate versus rhythm control methods.

The rennin-angiotensin-aldosterone system might be a mediator for atrial structural and electrical remodeling in AF. A new study called LIFE (Losartan Intervention for End point Reduction in Hypertension) showed that the ACE-I s, Statins and ARBs can significantly reduce the occurrence of a stroke when compared to the above mentioned blockers, despite analogous blood pressure reductions. Even independently also the ACE-Is and ARBs work better. The mechanism of ACE-I and ARB is unknown, but could involve regression of hypertrophy and reversal or atrial remodeling.

Studies will be continually looking out for novel strategies to decrease the occurrence of Atrial Fibrillation. As we come to understand and realize the underlying mechanisms of the inflammation and rennin-angiotensin-aldosterone system, we can use the combined power of the existing therapies to combat AF. Even the old rate versus rhythm control debate can be used to find new approaches to help our patients.

 

Article Source: http://www.articlecell.com

About The Author
Judah98 Friedman98

Judah Friedman is the author of this article on Cardiovascular Consultants. Find more information about Cardiovascular Consultants here.



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