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Atrial Fibrillation

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Clinical Handbook of Cardiac Electrophysiology

Abstract

AF is the most common sustained arrhythmia seen in clinical practice with an overall prevalence of 700–750 per 100,000 of the population in North America (Chugh et al., Circulation 129:837–847, 2014). In addition to causing considerable adverse sequelae and an increase in hospitalizations, there is a five-fold increase in the risk of stroke associated with non-valvular AF (Wolf et al., Stroke 22:983–988, 1991) which increases by a factor of 17 in the presence of significant valvular heart disease (Fuster et al., Circulation 123:e269–e367, 2011). The risk of AF increases markedly with older age affecting approximately 5% of people over 65 years and 10% of people age over 80 years (Miyasaka et al., Circulation 2006; 12: 114–119, 2006).

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References

  • Abed HS, Wittert GA, Leong DP, et al. Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial. JAMA. 2013;310:2050–60.

    Article  CAS  PubMed  Google Scholar 

  • Benjamin EJ, Levy D, Vaziri SM, et al. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA. 1994;271:840–4.

    Article  CAS  PubMed  Google Scholar 

  • Brooks AG, Wilson L, Kuklik P, et al. Image integration using NavX fusion: initial experience and validation. Heart Rhythm. 2008;5:526–35.

    Article  PubMed  Google Scholar 

  • Cabrera A, Ho SY, Climent V, et al. Morphological evidence of muscular connections between contiguous pulmonary venous orifices: relevance of the interpulmonary isthmus for catheter ablation in atrial fibrillation. Heart Rhythm. 2009;6(8):1192–8.

    Article  PubMed  Google Scholar 

  • 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: a report of the heart rhythm society (HRS) task force on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2012;9:632–96.

    Article  PubMed  Google Scholar 

  • Chen YH, Xu SJ, Bendahhou, et al. KCNQ1 gain-of-function mutation in familial atrial fibrillation. Science. 2003;299(5604):251–4.

    Article  CAS  PubMed  Google Scholar 

  • Chinitz JS, Gerstenfeld EP, Marchlinski FE, et al. Atrial fibrillation is common after ablation of isolated atrial flutter during long-term follow-up. Heart Rhythm. 2007;4:1029–33.

    Article  PubMed  Google Scholar 

  • Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease Study 2010. Circulation. 2014;129:837–47.

    Article  PubMed  Google Scholar 

  • Chung MK, Martin DO, Sprecher D, Wazni O, Kanderian A, Carnes CA, et al. C-reactive protein elevation in patients with atrial arrhythmias: inflammatory mechanisms and persistence of atrial fibrillations. Circulation. 2001;104:2886–91.

    Article  CAS  PubMed  Google Scholar 

  • Colish J, Walker JR, Elmayergi N, Almutairi S, Alharbi F, Lytwyn M, Francis A, Bohonis S, Zeglinski M, Kirkpatrick ID, Sharma S, Jassal DS. Obstructive sleep apnea: effects of continuous positive airway pressure on cardiac remodeling as assessed by cardiac biomarkers, echocardiography, and cardiac MRI. Chest. 2012;141:674–81.

    Article  PubMed  Google Scholar 

  • Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361:1139–51.

    Article  CAS  PubMed  Google Scholar 

  • Connolly SJ, Eikelboom J, Joyner C, et al. Apixaban in patients with atrial fibrillation. N Engl J Med. 2011;364:806–17.

    Article  CAS  PubMed  Google Scholar 

  • Dagenais GR, Pogue J, Fox K, Simoons ML, Yusuf S. Angiotensin-converting-enzyme inhibitors in stable vascular disease without left ventricular systolic dysfunction or heart failure, a combined analysis of three trials. Lancet. 2006;368:581–8.

    Article  CAS  PubMed  Google Scholar 

  • Darbar D, Herron KJ, Ballew JD, Jahangir A, Gersh BJ, Shen WK, Hammill SC, Packer DL, Olson TM. Familial atrial fibrillation is a genetically heterogeneous disorder. J Am Coll Cardiol. 2003;41:2185–92.

    Article  PubMed  Google Scholar 

  • Di Carli MF, Bianco-Batlles D, Landa ME, et al. Effects of autonomic neuropathy on coronary blood flow in patients with diabetes mellitus. Circulation. 1999;100:813–991.

    Article  PubMed  Google Scholar 

  • Dimmer C, Tavernier R, Gjorgov N, et al. Variations of autonomic tone preceding onset of atrial fibrillation after coronary artery bypass grafting. Am J Cardiol. 1998;82:22–5.

    Article  CAS  PubMed  Google Scholar 

  • Dublin S, Glazer NL, Smith NL, et al. Diabetes mellitus, glycemic control, and risk of atrial fibrillation. J Gen Intern Med. 2010;25:853–8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ellinor PT, Lunetta KL, Glazer NL, et al. Common variants in KCNN3 are associated with lone atrial fibrillation. Nat Genet. 2010;42(3):240–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Electrophysiological evaluation of pulmonary vein isolation. Europace. 2009;11:1423–33.

    Google Scholar 

  • Fein A, Shvilkin A, Shah D, et al. Treatment of obstructive sleep apnea reduces the risk of atrial fibrillation recurrence–after catheter ablation. JACC. 2013;62(4):300–5.

    Article  PubMed  Google Scholar 

  • Fox CS, Parise H, D’Agostino RB Sr, Lloyd-Jones DM, Vasan RS, Wang TJ, Levy D, Wolf PA, Benjamin EJ. Parental atrial fibrillation as a risk factor for atrial fibrillation in offspring. JAMA. 2004;291:2851–5.

    Article  CAS  PubMed  Google Scholar 

  • Frey WC, Pilcher J. Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery. Obes Surg. 2003;13:676–83.

    Article  PubMed  Google Scholar 

  • Frost L, Hune LJ, Vestergaard P. Overweight and obesity as risk factors for atrial fibrillation or flutter: the Danish Diet, Cancer, and Health Study. Am J Med. 2005;118:489–95.

    Article  PubMed  Google Scholar 

  • Frustaci A, Chimenti C, Bellocci F, Morgante E, Russo MA, Maseri A. Histological substrate of atrial biopsies in patients with lone atrial fibrillation. Circulation. 1997;96:1180–4.

    Article  CAS  PubMed  Google Scholar 

  • Fuster V, Ryden LE, Cannom DS, et al. 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;123:e269–367.

    PubMed  Google Scholar 

  • Goette A, Bukowska A, Dobrev D, et al. Acute atrial tachyarrhythmia induces angiotensin II type receptor-mediated oxidative stress and microvascular flow abnormalities in the ventricles. Eur Heart J. 2009;30:1411–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Granger CB, Alexander JH, McMurray JJV, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365:981–92.

    Article  CAS  PubMed  Google Scholar 

  • Gupta A, Perera T, Ganesan A, et al. Complications of catheter ablation of atrial fibrillation. Circ Arrhythm Electrophysiol. 2013;6:1082–8.

    Article  PubMed  Google Scholar 

  • Haissaguerre M, Jais P, Shah DC, Takahashi A, Hocini M, Quiniou G, Garrigue S, Le Mouroux A, Le Metayer P, Clementy J. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339:659–66.

    Article  CAS  PubMed  Google Scholar 

  • Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007;146:857–67.

    Article  PubMed  Google Scholar 

  • Healey JS, Baranchuk A, Crystal E, et al. Prevention of atrial fibrillation with angiotensin converting enzyme inhibitors and angiotensin receptor blockers. A meta-analysis. J Am Coll Cardiol. 2005;45:1832–9.

    Article  CAS  PubMed  Google Scholar 

  • Ho SY, Cabrera A, Sanchez-Quintana D. Left atrial anatomy revisited. Circulation. 2012;5:220–8.

    PubMed  Google Scholar 

  • Jais P, Hocini M, Hsu LF, et al. Technique and results of linear ablation at the mitral isthmus. Circulation. 2004;110:2996–3002.

    Article  PubMed  Google Scholar 

  • Kim JS, Jongnarangsin K, Latchamsetty R, et al. The optimal range of international normalized ratio for radiofrequency catheter ablation of atrial fibrillation during therapeutic anticoagulation with warfarin. Circ Arrhythm Electrophysiol. 2013;6:302–9.

    Article  PubMed  Google Scholar 

  • Lakkireddy D, Reddy YM, Di Biase L. Feasibility and safety of dabigatran versus warfarin for periprocedural anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation: results from a multicenter prospective registry. J Am Coll Cardiol. 2012;59:1168–74.

    Article  CAS  PubMed  Google Scholar 

  • Lakkireddy D, Reddy YM, Di Biase L, et al. Feasibility & safety of uninterrupted rivaroxaban for periprocedural anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation: results from a multicenter prospective registry. J Am Coll Cardiol. 2014;63:982–8.

    Article  CAS  PubMed  Google Scholar 

  • Liu L, Nattel S. Differing sympathetic and vagal effects on atrial fibrillation in dogs: role of refractoriness heterogeneity. Am J Phys. 1997;273:805–16.

    Google Scholar 

  • Luik A, Radzewitz A, Kieser M, et al. Cryoballoon versus open irrigated radiofrequency ablation in patients with paroxysmal atrial fibrillation: the prospective, randomised, controlled, non-inferiority freeze AF study. Circulation. 2015;132:1311–9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Magnani JW, Johnson VM, Sullivan LM, Gorodeski EZ, Schnabel RB, Lubitz SA, Levy D, Ellinor PT, Benjamin EJ. P wave duration and risk of longitudinal atrial fibrillation in persons >/= 60 years old (from the Framingham Heart Study). Am J Cardiol. 2011;107:917–21.

    Article  PubMed  PubMed Central  Google Scholar 

  • Magnani JW, Lopez FL, Soliman EZ, Maclehose RF, Crow RS, Alonso A. P wave indices, obesity, and the metabolic syndrome: the atherosclerosis risk in communities study. Obesity. 2012;20:666–72.

    Article  PubMed  Google Scholar 

  • Miyasaka Y, Barnes ME, Gersh BJ. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation. 2006;12:114–9.

    Google Scholar 

  • Munger TM, Dong YX, Masaki M, et al. Electrophysiological and hemodynamic characteristics associated with obesity in patients with atrial fibrillation. J Am Coll Cardiol. 2012;60:851–60.

    Article  PubMed  Google Scholar 

  • Nademanee K, McKenzie J, Kosar E, et al. A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate. J Am Coll Cardiol. 2004;43:2044–53.

    Article  PubMed  Google Scholar 

  • Narayan SM, Krummen DE, Shivkumar K, et al. Treatment of atrial fibrillation by the ablation of localized sources-CONFIRM (Conventional ablation for atrial fibrillation with or without focal impulse and rotor modulation) trial. J Am Coll Cardiol. 2012;60:628–3.

    Article  PubMed  PubMed Central  Google Scholar 

  • Narayan SM, Shivkumar K, Krummen DE, et al. Panoramic electrophysiological mapping but not electrogram morphology identifies stable sources for human atrial fibrillation: stable atrial fibrillation rotors and focal sources relate poorly to fractionated electrograms. Circ Arrhythm Electrophysiol. 2013a;6:58–67.

    Google Scholar 

  • Narayan SM, Krummen DE, Clopton P, et al. Direct or coincidental elimination of stable rotors or focal sources may explain successful AF ablation: on-treatment analysis of the CONFIRM trial. J Am Coll Cardiol. 2013b;60:138–47.

    Google Scholar 

  • Otto ME, Belohlavek M, Romero‐Corral A, Gami AS, Gilman G, Svatikova A, Amin RS, Lopez‐Jimenez F, Khandheria BK, Somers VK. Comparison of cardiac structural and functional changes in obese otherwise healthy adults with versus without obstructive sleep apnea. Am J Cardiol. 2007;99:1298–302.

    Article  PubMed  Google Scholar 

  • Pandit SV, Jalife J. Rotors and the dynamics of cardiac fibrillation. Circ Res. 2013;112:849–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Patel N, Kay GN, Sanchez J, Ideker RE, Smith WM. Discrimination of left atrial and pulmonary vein potentials in patients with paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2003;14:698–704.

    Article  PubMed  Google Scholar 

  • Patel D, Mohanty P, Di Biase L, et al. Safety and efficacy of pulmonary vein antral isolation in patients with obstructive sleep apnea–the impact of continuous positive airway pressure. Circ Arrhythm Electrophysiol. 2010;3:445–51.

    Article  PubMed  Google Scholar 

  • Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365:883–91.

    Article  CAS  PubMed  Google Scholar 

  • Pathak R, Middeldorp M, Lau D, et al. Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation. The ARREST-AF study. JACC. 2014;64(21):2222–31.

    Article  PubMed  Google Scholar 

  • Pop-Busui R, Kirkwood I, Schmid H, et al. Sympathetic dysfunction in type 1 diabetes: association with impaired myocardial blood flow reserve and diastolic dysfunction. J Am Coll Cardiol. 2004;4:2368–74.

    Article  CAS  Google Scholar 

  • Proietti R, Santangeli P, Di Biase L, et al. Comparative effectiveness of wide antral versus ostial pulmonary vein isolation: a systematic review and meta-analysis. Circ Arrhythm Electophysiol. 2014;7:39–45.

    Article  Google Scholar 

  • Providência R, Albenque JP, Combes S, et al. Safety and efficacy of dabigatran versus warfarin in patients undergoing catheter ablation of atrial fibrillation: a systematic review and meta-analysis. Heart. 2014;100:324–35.

    Article  PubMed  CAS  Google Scholar 

  • Sacre JW, Franjic B, Jellis CL, et al. Association of cardiac autonomic neuropathy with subclinical myocardial dysfunction in type 2 diabetes. JCMG. 2010;3:1207–15.

    Google Scholar 

  • Schneider R, Lauschke J, Tischer T, et al. Pulmonary vein triggers play an important role in the initiation of atrial flutter: initial results from the prospective randomized Atrial Fibrillation Ablation in Atrial Flutter (Triple A) trial. Heart Rhythm. 2015;12:865–71.

    Article  PubMed  Google Scholar 

  • Steven D, Sultan A, Reddy V, et al. Benefit of pulmonary vein isolation guided by loss of pace capture on the ablation line: results from a prospective 2-center randomized trial. J Am Coll Cardiol. 2013;62:44–50.

    Article  PubMed  Google Scholar 

  • Stritzke J, Markus MR, Duderstadt S, Lieb W, Luchner A, Döring A, Keil U, Hense HW, Schunkert H, MONICA/KORA Investigators. The aging process of the heart: obesity is the main risk factor for left atrial enlargement during aging the MONICA/KORA (monitoring of trends and determinations in cardiovascular disease/cooperative research in the region of Augsburg) study. J Am Coll Cardiol. 2009;54:1982–9.

    Article  PubMed  Google Scholar 

  • Takahashi A, Iesaka Y, Takahashi Y, et al. Electrical connections between pulmonary veins: implication for ostial ablation of pulmonary veins in patients with paroxysmal atrial fibrillation. Circulation. 2002;105:2998–3003.

    Article  PubMed  Google Scholar 

  • Tesfaye S, Chaturvedi N, Eaton SE, et al. Vascular risk factors and diabetic neuropathy. N Engl J Med. 2005;352:341–50.

    Article  CAS  PubMed  Google Scholar 

  • Troughton RW, Crozier I. Fine tuning risk stratification for atrial fibrillation. J Am Coll Cardiol. 2013;61(22):2285–7.

    Article  PubMed  Google Scholar 

  • Walenga JM, Adiguzel C. Drug and dietary interactions of the new and emerging oral anticoagulants. Int J Clin Pract. 2010;64:956–67.

    Article  CAS  PubMed  Google Scholar 

  • Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22:983–8.

    Article  CAS  PubMed  Google Scholar 

  • Zacharias A, Schwann TA, Riordan CJ, Durham SJ, Shah AS, Habib RH. Obesity and risk of new-onset atrial fibrillation after cardiac surgery. Circulation. 2005;112:3247–55.

    Article  PubMed  Google Scholar 

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Haissaguerre, M., Glover, B.M., Brugada, P. (2021). Atrial Fibrillation. In: Glover, B.M., Brugada, P. (eds) Clinical Handbook of Cardiac Electrophysiology. Springer, Cham. https://doi.org/10.1007/978-3-030-74319-2_8

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