Non-surgical treatment and prevention of atrial fibrillation

Abstract

Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Electrical, contractile and structural remodeling of the left atrium underlies the development of AF. AF can be classified as paroxysmal if the arrhythmia terminates within 7 days, persistent if it lasts longer than 7 days, or permanent if cardioversion was not attempted or failed. AF can be further classified according to mechanism of initiation. In general, AF can be expected to recur, although the pattern and tempo of recurrence is widely variable. AF is considered recurrent after two or more episodes, regardless of whether the patient is symptomatic. Initial diagnosis of AF should include a thorough evaluation including family history of arrhythmia, structural heart disease and thyroid disorders. Management of new-onset AF may include electrical or pharmacologic cardioversion. Chronic management emphasizes symptom control and prevention of heart failure and thromboembolic disease through either a rate or rhythm control strategy and anticoagulation. For those who remain symptomatic, catheter ablation or surgical Maze procedure may be considered. As conventional antiarrhythmic medications are limited by efficacy and side effects, efforts are underway to identify therapeutics aimed at preventing conditions associated with the development of AF including hypertension and arrhythmogenic remodeling.