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2001, Number 5

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Gac Med Mex 2001; 137 (5)

Atrial Fibrillation. New Aspects of an Old Disease.

Enrique Asensio-Lafuente, José Benito Alvarez-Mosquera, J. Enrique Lozano-Díaz, Alfonso Farías Vega, René Narváez-David, Joel Dorantes-García, Arturo Orea-Tejeda, Verónica Rebollar-González, J. Manuel Portos-Silva, Jorge Oseguera-Moguel

Language: Spanish
References: 82
Page: 445-458
PDF size: 119.17 Kb.


ABSTRACT

Atrial fibrillation (Afib) is clinically the most common arrhythmia. Its main complications are recurrent embolic events and a variable deterioration of functional class. Atrial fibrillation induces changes in cellular ionic channels that self-perpetuate the arrhythmia. The pharmacologic treatment of Afib is directed toward correction of those changes and return to sinus rhythm. It is also intended to maintain adequate heart rates and prevent embolic events through anticoagulation or platelet antiagregation. There are presently several class IC or class III antiarrhythmics available for attempting a return to sinus rhythm. The success rates are irregular, the best achieved with flecainide or propafenone among patients without structural heart disease. Amiodarone is the best choice when there is such a problem. The combination possibilities are huge, so that each case must be individualized. The new class III antiarrhythmics are very effective, but have a relatively high rate of side effects including torsade de pointes. Anticoagulation should be the preferred treatment among the majority of patients, but each case should be individually evaluated. New therapies such as focal or linear catheter ablation techniques, atrial or biatrial programmed stimulation, and atrial cardioverter-defibrillator need longer follow-up and experience to be objectively evaluated, although there are reasons to be optimistic in the future, even if patients need antiarrhythmic support at present. Surgery has high morbi-mortality rates, so it is not the preferred approach.


REFERENCES

  1. Olsson B, Allessie M, Campbell R. (eds.) Atrial Fibrillation, Mechanisms and therapeutic strategies. Futura 1994; pp1-13.

  2. Boysen G, Nyboe J, Apleyard M et al. Stroke incidence and risk factors for stroke in Copenhagen, Denmark. Stroke 1988;19:1345-53.

  3. Lake F, Cullen K, de Klerk N, McCall M, Rosman D. Atrial fibrillation and mortality in an elderly population. Aust NZ J Med, 1989;19:321-6.

  4. Wolf P, Dawber T, Thomas H, Kannel W. Epidemiologic assessment of chronic atrial fibrillation and the risk of stroke: The Framingham study. Neurology, 1978;28:973-7.

  5. Mogensen L. Fibrillating atzial a sizeable problem, or rather, atrial fibrillation: a striking problem. J Int Med, 1993;233:373-5.

  6. Wijffels M, Kirchhof C, Boersma L, Allessie M. Atrial fibrillation begets atrial fibrillation. En: Olsson B, Allessie M, Campbell R (eds.) Atrial Fibrillation, Mechanisms and therapeutic strategies. Futura 1994, pp195-201.

  7. Goette A, Honeycutt C, Langberg J. Electrical remodeling in atrial fibrillation: Time course and mechanisms. Circulation 1996;94:2968-74.

  8. Le Heuzey J, Boutjdir M, Gagey S. Cellular aspects of atrial vulnerability. En: Attuel P, Coumel P, Janse M eds: The atrium in health and disease. Futura Co. 1989 pp: 81-94.

  9. Geenspon A, Schaal S. “The holiday Heart” electrophy-siologic studies of alcohol effects in alcoholics. Ann Intern Med 1983;93:135-42.

  10. Zehender M, Meinertz T, Keul J. ECG variants and cardiac arrhythmias in athletes: clinical relevance and prognostic importance. Am Heart J 1990,119:1378.

  11. Brugada R, Tapscott T, Czernuazewicz G, Marian A, Iglesias A, Mont L, et al. Identification of a genetic locus for familial atrial fibrillation. N Engl J Med 1997, Mar 27;336(13):905-11.

  12. Brugada R, Brugada J, Roberts R. Genetics of cardiovascular disease with emphasis on atrial fibrillation. J Interv cardiol Electrophysiol 1999;3(1):7-13.

  13. Morillo C, Klein G, Jones D, Guiraudon C. Chronic rapid atrial pacing: structural, functional and electrophysiological characteristics of a new model of sustained atrial fibrillation. Circulation 1995;91:1588-95.

  14. Allessie M, Konings K, Kirchhof C. Mapping of atrial fibrillation. En: Olsson B, Allessie M, Campbell R (eds.) Atrial Fibrillation, Mechanisms and therapeutic strategies. Futura 1994, pp 37-49.

  15. Gray R, Pertsov A, Jalife J. Incomplete reentry and epicardial breakthrough patterns during atrial fibrillation in the sheep heart. Circulation 1996;94:2649-61.

  16. Papageorgiou P, Monahan K, Boyle N, Seifert M, Beswick P, Zebede J et al. Site-dependent intra-atrial conduction delay: relationship to initiation of atrial fibrillation. Circulation 1996;94:384-9.

  17. Pristowsky E. Overview on atrial fibrillation ablation. Medscape, North American Society of Pacing and Electrophysiology (NASPE) 21st annual scientific sessions, 17 May 2000, Comunicación internet: http://www.medscape.com/Medscape/CNO/2000/story.cm?story_id1210

  18. Wang J, Liu L, Feng J, Nattel S. Regional and functional factors determining induction and maintenance of atrial fibrillation in dogs. Am J Physiol 1996;40:H148-58.

  19. Murgatroyd F, Camm J. Atrial arrhythmias. Lancet; 341:1317-22.

  20. Task Force of the Working Group on Arrhythmias of the European Society of Cardiology. The “Sicilian Gambit”: a new approach to the classification of antiarrhythmic drugs based on their actions on arrhythmogenic mechanisms. Eur Heart J 1991;12:1112-31.

  21. Satoh T, Zipes D. Unequal atrial stretch in dogs increases dispersion of refractoriness conductive to developing atrial fibrillation. J Cardiovasc Electrophysiol 1996;7:833-42.

  22. Konings K, Kirchof C, Smeets J, Wellens H, Penn O, Allessie M. High density mapping of electrically induced atrial fibrillation in humans. Circulation 1994;89:1665-80.

  23. Pfeiffer D, Prakash A, Giorgberidze I, Tebbenjohans J, Lüderitz B, Saksena S. Electrophysiology of atrial flutter/fibrillation. En: Saksena S, Lüderitz B (eds.) Interventional electrophysiology, a textbook. Futura P. Co. 1996;pp 49-67.

  24. Werkö L. Atrial fibrillation: Introduction. En: Olsson B, Allessie M, Campbell R (eds.) Atrial Fibrillation, Mechanisms and therapeutic strategies. Futura 1994, pp 1-13.

  25. Zipes D. Specific Arrhythmias: Diagnosis and treatment. En: Braunwald E. (Ed) Heart Disease. A textbook of cardiovascular medicine. 5ª ed. Ed. Saunders Pub. Co. 1997. pp 640-705.

  26. Myerburg R, Kessler K, Castellanos A. Recognition, clinical assessment and management of arrhythmias and conduction disturbances. En Schlant R, Alexander W, O’Rourke R, Roberts R, Sonnenblick E.(eds) Hurst’s The heart. 8ª ed. McGraw Hill, 1994 pp 725-8.

  27. Conover M. Electrocardiografía práctica. 1ª ed. Doyma/Mosby 1995 pp 51-5.

  28. Schlepper M. Identification of patients with atrial fibrillation at risk for thromboembolism. En: Olsson B, Allessie M, Campbell R (eds.) Atrial Fibrillation, Mechanisms and therapeutic strategies. Futura 1994, pp 15-24.

  29. Winkler R, Gök R, Klein B, Beeck H, Hellstern P, Taubert G et al. Alterations of release pattern of endothelial dependent hemostatic factors and cell adhesion molecules in nonvalvular atrial fibrillation. J Am Coll Cardiol, Feb 2000;35(2):103 A (resumen).

  30. Morley J, Marinchak R, Rials S, Kowey P. Atrial fibrillation, anticoagulation and stroke. Am J Cardiol. Ene 25, 1996;77(3):38A-44A.

  31. Howard P. Guidelines for stroke prevention in patients with atrial fibrillation. Drugs, Dec 1999;58(6):997-1009.

  32. Prystowsky E, Benson W, Fuster V, Hart R, Kay N, Myerburg R et al. Management of patients with atrial fibrillation. Circulation 1996;93:1262-77.

  33. Turazza F, Franzosi M. Is anticoagulation therapy underused in elderly patients with atrial fibrillation? Drugs Aging, Mar 1997;10(3):174-84.

  34. Stroke prevention in atrial fibrillation investigators. Adjusted dose warfarin versus low-intensity fixed dose warfarina plus aspirin for high risk patients with atrial fibrillation: Stroke prevention in atrial fibrillation III randomized clinical trial. Lancet 1996;348:633-38.

  35. Heras M, Fernández-Ortiz A, Gómez J, Iriarte J, Lidón RM. Guías de actuación clínica de la Sociedad Española de Cardiología: Recomendaciones para el uso del tratamiento antitrombótico en Cardiología. Rev Esp Cardiol Oct 1999;52(10):801-20.

  36. Adhiyaman V, Kamalakannan D, Oke A, Shah I, White A. Underutilization of antithrombotic therapy in atrial fibrillation. JR Soc Med, Mar 2000;93(3):138-40.

  37. Wensley S, Keir S Caine S, Mac Mahon M. Additional risk factors in atrial fibrillation patients not receiving warfarin. Age Ageing Jul 1999;28(4):355-7.

  38. Hart R, Pearce L, Rothbart R, McAnulty J, Singer R, Halperin J. Stroke with intermittent atrial fibrillation: Incidence and predictors during aspirin therapy. J Am Coll Cardiol 2000;35(1):183-7.

  39. Demirkan K, Stephens M, Newman K, Self T. Response to warfarin and other oral anticoagulants: Effects of disease states. South Med J 2000;93(5):448-55.

  40. Gage B, Cardinalli A, Owens D. Cost-effectiveness of preference-based antithrombotic therapy for patients with nonvalvular atrial fibrillation. Stroke, Jun 1998;29(6):1083-91.

  41. Posada I, Barriales V. Alternate-day dosing of aspirin in atrial fibrillation. Am Heart J, 1999;138:137-43.

  42. Vereckei A, Vera Z, Pride H, Zipes D. Atrioventricular nodal conduction rather than automaticity determines the ventricular rate during atrial fibrillation and atrial flutter. J Cardiovasc Electrophysiol 1992;3:534-43.

  43. Nagayoshi H, Janota T, Hnatkova K, Camm J, Malik M. Autonomic modulation of ventricular rate in atrial fibrillation. Am J Physiol 1997;41:H1643-9.

  44. García Bolao I. Cardioversión farmacológica en la fibrilación auricular de inicio reciente. En Brugada J. (Ed). Fibrilación auricular. Edición patrocinada por 3M 1998, pp 87-93.

  45. Sabaté X, Romero C. Fármacos frenadores del nodo AV. En Brugada J. (Ed). Fibrilación auricular. Edición patrocinada por 3M 1998, pp 113-18.

  46. Karki K, Boman K, Lowheim O, Dahlen C, Bandh S, Abjorn C et al. Intravenous digoxin in acute atrial fibrillation. Results f a randomized, placebo-controlled multicentre trial in 239 patients. Eur Heart J 1997;18:649-54.

  47. Heywood J. Calcium channel blockers for heart rate control in atrial fibrillation complicated by congestive heart failure. Can J Cardiol 1995;11:823-6.

  48. Froelicher V. Diltiazem and exercise performance in patients with chronic atrial fibrillation. Chest 1988;93:20-5.

  49. Ali A, Sanalla A, Clark V. Beta-blocker effects on post-operative atrial fibrillation. Eur J Cardiothorac Surg 1997;11:1154-7.

  50. Ueshima K, Myers J, Ribisl P, Morris C, Kawaguchi T, Liu J et al. Exercise capacity and prognosis in patients with chronic atrial fibrillation. Cardiology 1995;86:108-13.

  51. Farshi R, Kistner D, Sarma J, Longmate J, Singh B. Ventricular rate control in chronic atrial fibrillation during daily activity and programmed exercise: A crossover open-label study of five drug regimens. J Am Coll Cardiol, 1999;33:304-10.

  52. Moya A. Modulación del Nodo AV mediante radiofrecuencia. En Brugada J. (Ed). Fibrilación auricular. Edición patrocinada por 3M 1998, pp 119-24.

  53. Touboul P, Canu G, Claudel J, Moncada E, Kirkorian G. His bundle ablation for atrial fibrillation: Indications and results. En: Olsson B, Allessie M, Campbell R (eds.) Atrial Fibrillation, Mechanisms and therapeutic strategies. Futura 1994, pp 307-23.

  54. Fernández I, Márquez J, Merino J, Bautista A, de Artaza M. Ablación del nodo AV y marcapasos definitvo. En: Brugada J. (Ed). Fibrilación auricular. Edición patrocinada por 3M 1998, pp 125-30.

  55. Kochiadakis G, Igoumenidis N, Parthenakis F, Chlouverais G, Vardas P. Amiodarone versus propafenone for conversion of chronic atrial fibrillation: a randomized, controlled study. J Am Coll Cardiol 1999;33:966-71.

  56. Donovan K, Power B, Hockings B, Dobb G, Lee K. Intravenous flecainide versus amiodarone for recent onset atrial fibrillation. Am J Cardiol 1995;75, 693-7.

  57. Ganz L, Antman E. Antiarrhythmic drug therapy in the management of atrial fibrillation. J Cardiovasc Electrophysiol, 1997;8:1175-89.

  58. Falk R. Flecainide induced ventricular tachycardia and fibrillation in patients treated for atrial fibrillation. Ann Intern Med 1989;111:107-11.

  59. Packer D, Munger T, Johnson S, Cragun K. Mechanism of lethal proarrhythmia observed in the Cardiac Arrhythmia Supression Trial: Role of adrenergic modulation of drug binding Pacing Clin electrophysiol 1997;20(1):11-6.

  60. Hohnloser S, Li Y, Bender B, Gronefeld G. Pharmacological management of atrial fibrillation, an update. J Cardiovasc Pharmacol ther. 2000;5(1):11-16.

  61. Opolski G, Stanislawaska J, Gorecki A, Swiecicka G, Torbicki G, Kraska T. Amiodarone in restoration and maintenance of sinus rhythm in patients with chronic atrial fibrillation after unsuccessful direct-current cardioversion. Clin Cardiol 1997;20:337-40.

  62. Packer D. Contemporary management of atrial fibrillation. ACC Scientific session 2000, Marzo 13, 2000:http://www.medscape.com/medscape/CNO/2000/ACC/Story. cfm?story_id-1081

  63. Levy S, Breithard G, Campbell R. (eds). Atrial fibrillation:Current knowledge and recommendations for management. Working Group on Arrhythmias of the European Society of Cardiology. Eur Heart J 1998;19(9):1 294-320.

  64. Yue L, Feng J, Wang Z, Nattel S. Effects of ambasilide, quinidine, flecainide and verapamil on ultra rapid delayed rectifier potassium currents in canine arial myocites. Cardiovasc Res 2000 46(1):151-61.

  65. Camm J. Safety of antiarrhythmic agents: The final frontier in treating atrial fibrillation? Medscape, 21 Mar 2000: http://www.medscape.com/Medscape/cardiology/treatmentUpdate/ 2000/tu03/public/toc-tu03.html

  66. Ellenbogen , Stambler B, Wood M, Sager P, Wesley R, Meissner M, et al. Efficacy of intravenous ibutilide for rapid termination of atrial fibrillation and atrial flutter. A dose response study. J Am Coll Cardiol 1996;28:130-6.

  67. Sedwick M, lip G, Rae A, Cobbe S. Chemical cardioversion of atrial fibrillation with intravenous dofetilide. Int J Cardiol 1995;49:159-66.

  68. Klein A, Grimm R, Black I, Leung D, Chung M, Vaughn S et al. Cardioversion guided by transesophageal echocardiography. The ACUTE pilot study. A randomized, controlled trial. Ann Intern Med 1997;126:200-9.

  69. Bianconi L, Mennuni M, Lukic V, Castro A, Chieffi M, Santini M. Effectcs of oral propafenone administration before electrical cardioversión of chronic atrial fibrillation. A placebo controlled study. J Am Coll Cardiol 1996;28:700-6.

  70. Alt E, Schmitt C, Ammer R, Plewan A, Evans F, Pasquantonio J, et al. Effect of electrode position on outcome of low-energy intracardiac cardioversión of atrial fibrillation. Am J Cardiol 1997;79:621-5.

  71. Schmitt C, Alt E, Plewan A, Ammer R, Leibig M, Karch M et al. Low energy intracardiac cardioversión after failed conventional external cardioversión of atrial fibrillation. J Am Coll Cardiol 1996;28:994-9.

  72. Cox J, Boineau J, Schuessler R, Kater K, Lappas D. Five years experience with the Maze procedure for atrial fibrillation. Ann Thorac Surg, 1993;56:814-24.

  73. García R, Martínez J, Ruiz R, Morell S, Otero E. Tratamiento quirúrgico de la fibrilación auricular: La técnica del “Maze”. En: Brugada J. (Ed). Fibrilación auricular. Edición patrocinada por 3M 1998, pp 131-4.

  74. Jaïs P, Haïssaguerre M, Shah D, Chouairi S, Gencel P, Hocini M et al. A focal source of atrial fibrillation treated by discrete radiofrequency ablation. Circulation 199795:572-6.

  75. Ernst S, Ouyang F, Cappato R, Volkmer M, Bänsch D, Hebe J et al. Catheter ablation of atrial fibrillation by linear lesions: Where to draw the line? J Am Coll Cardiol Feb 2000;35(2):122 A (resumen).

  76. Seidl K, Beatty G, Drögemüller A, Breunung S, Rameken M, Senges J. Catheter based right and left atrial compartmentalization procedure in chronic atrial fibrillation using a novel non-contact mapping system: feasibility and safety. J Am Coll Cardiol Feb 2000;35(2):123 A (resumen).

  77. Saksena S, Prakash A, Krol R, Sroczynski H, Woodruff V, Mackenzie P. Dual site right atrial pacing is effective for long term prevention of symptomatic chronic atrial fibrillation. J Am Coll Cardiol Feb 2000;35(2):108 A (resumen).

  78. Tse H, Lau C, Yu C, Teo W, Kam R, Ng K. Impact of dual site pacing on the natural history of symptomatic atrial fibrillation recurrence in patients without bradycardia. J Am Coll Cardiol Feb 2000;35(2):109 A (resumen).

  79. Levy S, Ricard P, Lau C, Lok N, Camm J, Murgatroyd F et al. Multicenter low energy transvenous atrial defibrillation (XAD) trial. Results in different subsets of atrial fibrillation. J Am Coll Cardiol 1997;29:750-55.

  80. Ricci R, Pandozi C, Altamura G, Toscano S, Miraglia F. Efficacy of anti-tachy-pacing (ATP) therapies and low energy cardioversión in terminating spontaneous atrial tachyarrhythmias in patients with dual implantable defibrillator. J Am Coll Cardiol Feb 2000;35(2):104 A (resumen).

  81. Madrid A, Seara J, Moro C. Perspectivas en la terapia con el desfibrilador auricular automático implantable. En: Brugada J. (Ed). Fibrilación auricular. Edición patrocinada por 3M 1998, pp 147-53.

  82. Ormaetxe JM, Idoate M. Fármacos preventivos post-cardioversión. En: Brugada J. (Ed). Fibrilación auricular. Edición patrocinada por £M 1998;105-112.




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