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Cardioversion in atrial fibrillation. Focus on recent-onset atrial fibrillation

  • SELECTED PAPER – ATRIAL FIBRILLATION
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Abstract

Atrial fibrillation is the most common sustained arrhythmia encountered in clinical practice. Its prevalence is rising due to an increasing elderly population and the improvement in management of life-threatening diseases such as myocardial infarction and heart failure. Over the past few years effective non-pharmacological treatments, new antiarrhythmics drugs, and anticoagulants have been introduced. Regardless of rate-control or rhythm control strategy, adequate stroke prevention still remains a cornerstone in the treatment of this arrhythmia. This review aims to illustrate the main practical issues in the management of atrial fibrillation, focusing on patients with recent-onset and hemodynamically stable atrial fibrillation.

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References

  1. Go AS, Hylek EM et al (2001) Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the ATRIA study. JAMA 285:2370–2375

    Article  PubMed  CAS  Google Scholar 

  2. Zarifis J, Beevers G, Lip GY (1997) Acute admissions with atrial fibrillation in a British multiracial hospital population. Br J Clin Pract 51(2):91–96

    PubMed  CAS  Google Scholar 

  3. Naccarelli GV, Varker H, Lin J, Schulman KL (2009) Increasing prevalence of atrial fibrillation and flutter in the United States. Am J Cardiol 104:1534–1539

    Article  PubMed  Google Scholar 

  4. Miyasaka Y, Barnes ME et al (2006) Secular trends on incidence of AF in Olmsted County, Minnesota, 1980 to 2000, and implications on the projection for future prevalence. Circulation 114:119–125

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  6. Bilato C, Corti MC, Baggio G et al (2009) Prevalence, functional impact, and mortality of atrial fibrillation in an older Italian population (from the Pro.VA. study). Am J Cardiol 104:1092–1097

    Article  PubMed  Google Scholar 

  7. Lloyd-Jones DM, Wang TJ, Leip EP et al (2004) Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation 110:1042–1046

    Article  PubMed  Google Scholar 

  8. Benjamin EJ, Wolf PA, D’Agostino RB et al (1998) Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 98:946–952

    Article  PubMed  CAS  Google Scholar 

  9. Steinberg JS, Sadaniantz A, Kron J et al (2004) Analysis of cause-specific mortality in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. Circulation 109:1973–8190

    Article  PubMed  Google Scholar 

  10. McDonald AJ, Pelletier AJ et al (2008) Increasing US emergency department visit rates and sub-sequential hospital admission for atrial fibrillation from 1993 to 2004. Ann Emerg Med 51:58–65

    Article  PubMed  Google Scholar 

  11. Friberg J, Buch P, Scharling H et al (2003) Rising rates of hospital admission for atrial fibrillation. Epidemiology 14:666–672

    Article  PubMed  Google Scholar 

  12. Ringborg A, Nieuwlaat R, Lindgren P et al (2008) Costs of atrial fibrillation in five European countries: results from the Euro Heart Survey on atrial fibrillation. Europace 10:403–411

    Article  PubMed  Google Scholar 

  13. Konings KTS, Kirchhof CJ, Smeets JR et al (1994) High density mapping of electrically induced atrial fibrillation in humans. Circulation 89:1665–1680

    Article  PubMed  CAS  Google Scholar 

  14. Haissaguerre M, Jais P, Shah DC et al (1998) Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 339:659–666

    Article  PubMed  CAS  Google Scholar 

  15. Allessie M, Ausma J, Schotten U (2002) Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovasc Res 54:230–246

    Article  PubMed  CAS  Google Scholar 

  16. Shinbane JS, Wood MA, Jensen DN et al (1997) Tachycardia induced cardiomyopathy: a review of animal models and clinical studies. J Am Coll Cardiol 29:709–715

    Article  PubMed  CAS  Google Scholar 

  17. Khan IA (2003) Atrial stunning: determinants and cellular mechanism. Am Heart J 145:787–794

    Article  PubMed  CAS  Google Scholar 

  18. The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC) (2010) Guidelines for the management of atrial fibrillation. Eur Heart J 31:2369–2429

    Google Scholar 

  19. Nieuwlaat R, Capucci A, Camm AJ et al (2005) Atrial fibrillation management: a prospective survey in ESC member countries. The Euro Heart Survey on atrial fibrillation. Eur Heart J 26:2422–2434

    Article  PubMed  Google Scholar 

  20. de Vos CB, Pisters R, Nieuwlaat R et al (2010) Progression from paroxysmal to persistent atrial fibrillation: clinical correlates and prognosis. J Am Coll Cardiol 55:725–731

    Article  PubMed  Google Scholar 

  21. Kirchhof P, Auricchio A, Bax J et al (2007) Outcome parameters for trials in atrial fibrillation: recommendations from a consensus conference organized by the German Atrial Fibrillation Competence NETwork and the EHRA. Europace 9:1006–1023

    Article  PubMed  Google Scholar 

  22. Raviele A, Disertori M, Alboni P et al (2011) Linee Guida AIAC per la gestione ed il trattamento della fibrillazione atriale. G Ital Cardiol 12(suppl 1):7–69

    Google Scholar 

  23. Page RL, Tilsh TW, Connolly SJ et al (2003) Asymptomatic or “silent” atrial fibrillation: frequency in untreated patients and patients receiving azimilide. Circulation 107:1141–1145

    Article  PubMed  Google Scholar 

  24. Lip GYH, Tse Hung-Fat (2007) Management of atrial fibrillation. Lancet 370:604–618

    Article  PubMed  Google Scholar 

  25. van der Hooft CS, Heeringa J, van Herpen G et al (2004) Drug-induced atrial fibrillation. J Am Coll Cardiol 44:2117–2124

    Article  PubMed  Google Scholar 

  26. Kozlowsky D, Budrejko S, Lip GY et al (2010) Lone atrial fibrillation: what do we know? Heart 96:498–453

    Google Scholar 

  27. Lamassa M, Di Carlo A et al (2001) Characteristic, outcome and care of stroke associated with atrial fibrillation in Europe: data from a multicenter multinational hospital-based registry. Stroke 32:392–398

    Article  PubMed  CAS  Google Scholar 

  28. Steger C, Pratter A et al (2004) Stroke patients with atrial fibrillation have a worse prognosis than patients without: data from the Austrian Stroke Registry. Eur Heart J 25:1734–1740

    Article  PubMed  Google Scholar 

  29. Fuster V, Ryden LE, ACC/AHA/ESC et al (2006) Guidelines for the management of patients with atrial fibrillation. J Am Coll Cardiol 48:854–906

  30. You JJ, Singer DE et al (2012) Antithrombotic therapy for atrial fibrillation. Antithrombotic therapy and prevention of thrombosis, 9th edn. ACCP Guidelines. Chest 141:e531–e575

  31. Wyse DG, Waldo AL, Di Marco JP, Atrial Fibrillation Follow-up Investigation of Rhythm Management Investigators et al (2002) A comparison of rate control and rhythm control in patients with atrial fibrillation (the AFFIRM study). N Engl J Med 347:1825–1833

    Google Scholar 

  32. De Denus S, Sanoski CA, Carlsson J et al (2005) Rate vs rhythm control in patients with atrial fibrillation: a meta-analysis. Arch Intern Med 165:258–262

    Article  PubMed  Google Scholar 

  33. Roy D, Talajic M, Nattel S, Atrial Fibrillation and Congestive Heart Failure Investigators et al (2008) Rhythm versus rate control for atrial fibrillation and heart failure. N Engl J Med 358:2667–2677

    Google Scholar 

  34. Sherman DG, Kim SG, Boop BS et al (2005) Occurrence and characteristics of stroke events in AFFIRM study. Arch Intern Med 165:1185–1191

    Article  PubMed  Google Scholar 

  35. Chevalier P, Durand-Dubief A, Burri H et al (2003) Amiodarone versus placebo and classic drugs for cardioversion of recent-onset atrial fibrillation: a meta-analysis. J Am Coll Cardiol 41:255–262

    Article  PubMed  CAS  Google Scholar 

  36. Kochiadakis GE, Igoumenidis NE, Hamilos ME et al (2007) A comparative study of the efficacy and safety of procainamide versus propafenone versus amiodarone for the conversion of recent-onset atrial fibrillation. Am J Cardiol 99:1721–1725

    Article  PubMed  CAS  Google Scholar 

  37. Madhuri N, Lekka KG, Santhosh KG (2011) Safety and efficacy of ibutilide in cardioversion of atrial fibrillation and flutter. J Am Board Fam Med 24:86–92

    Article  Google Scholar 

  38. Reisinger J, Gatterer E, Lang W et al (2004) Flecainide versus ibutilide for immediate cardioversion of atrial fibrillation of recent onset. Eur Heart J 25:1318–1324

    Article  PubMed  CAS  Google Scholar 

  39. Stiell IG, Clement C, Symington C et al (2007) Emergency departement use of intravenous procainamide for patients with acute atrial fibrillation or flutter. Acad Emerg Med 14:1158–1164

    Article  PubMed  Google Scholar 

  40. Camm AJ, Capucci A, Hohnloser SH, AVRO Investigators et al (2011) A randomized active-controlled study comparing the efficacy and safety of vernakalant to amiodarone in recent-onset atrial fibrillation. J Am Coll Cardiol 57(3):313–321

    Google Scholar 

  41. Alboni P, Botto GL, Baldi N et al (2004) Outpatient treatment of recent-onset atrial fibrillation with the “pill-in-the-pocket” approach. N Engl J Med 351:2384–2391

    Article  PubMed  CAS  Google Scholar 

  42. Gallagher MM, Yap YG, Padula M et al (2008) Arrhythmic complications of electrical cardioversion: relationship to shock energy. Int J Cardiol 123:307–312

    Article  PubMed  Google Scholar 

  43. Neumar RW, Otto CW, Link MS et al (2010) Adult advanced cardiovascular life support. AHA Guidelines. Circulation 122(suppl 3):S729–S767

    Google Scholar 

  44. Glover BM, Walsh SJ, Mccann CJ et al (2008) Biphasic energy selection for transthoracic cardioversion of atrial fibrillation. The BEST AF trial. Heart 94:884–887

    Article  PubMed  CAS  Google Scholar 

  45. Bellone A, Etteri M, Vettorello M et al (2012) Cardioversion of acute atrial fibrillation in the emergency department: a prospective randomised trial. Emerg Med J 29(3):188–191

    Article  PubMed  Google Scholar 

  46. Cristoni L, Tampieri A, Mucci F et al (2011) Cardioversion of acute atrial fibrillation in the short observation unit: comparison of a protocol focused on electrical cardioversion with simple antiarrhythmic treatment. Emerg Med J 28(11):932–937

    Article  PubMed  Google Scholar 

  47. Stiell IG, Perry JJ, Vaillancourt C et al (2010) Association of the Ottawa Aggressive Protocol with rapid discharge of emergency department patients with recent-onset atrial fibrillation or flutter. CJEM 12(3):181–191

    PubMed  Google Scholar 

  48. Dankner R, Shahar A, Novikov I et al (2009) Treatment of stable atrial fibrillation in the emergency department: a population based comparison of electrical direct current versus pharmacological cardioversion or conservative management. Cardiology 112(4):270–278

    Article  PubMed  Google Scholar 

  49. Decker WW, Smars PA, Vaidyanathan et al (2008) A prospective, randomized trial of an emergency department observation unit for acute onset atrial fibrillation. Ann Emerg Med 52:322–328

  50. Lo GK, Fatovic DM, Haig AD (2006) Biphasic cardioversion of acute atrial fibrillation in the emergency department. Emerg Med J 23:51–53

    Article  PubMed  CAS  Google Scholar 

  51. Burton JH, Vinson DR, Drummond K et al (2004) Electrical cardioversion of emergency department patients with atrial fibrillation. Ann Emerg Med 44:20–30

    Article  PubMed  Google Scholar 

  52. Koenig BO, Ross MA, Jackson RE (2002) An emergency department observation unit protocol for the management of patients with atrial fibrillation is feasible. Ann Emerg Med 39:374–381

    Article  PubMed  Google Scholar 

  53. Domanovits H, Schilinger M, Thoennissen J et al (2000) Termination of recent onset atrial fibrillation/flutter in the emergency department: a sequential approach with intravenous ibutilide and external cardioversion. Resuscitation 45:181–187

    Article  PubMed  CAS  Google Scholar 

  54. Marcius GM, Sung RJ (2001) Antiarrhythmics agents in facilitating electrical cardioversion of atrial fibrillation and promoting maintenance of sinus rhythm. Cardiology 95:1–8

    Article  Google Scholar 

  55. Van Gelder IC, Crijns HJ, Tieleman RG et al (1996) Chronic atrial fibrillation. Success of serial cardioversion therapy and safety of oral anticoagulation. Arch Intern Med 156:2585–2592

    Article  PubMed  Google Scholar 

  56. Golzari H, Cebul RD, Bahler RC (1996) Atrial fibrillation: restoration and maintenance of sinus rhythm and indications for anticoagulation therapy. Ann Intern Med 125:311–323

    PubMed  CAS  Google Scholar 

  57. Flaker GC, Fletcher KA, Rothbart RM, Stroke Prevention in Atrial Fibrillation (SPAF) Investigators et al (1995) Clinical and echocardiographic features of intermittent atrial fibrillation that predict recurrent atrial fibrillation. Am J Cardiol 76:355–358

    Article  PubMed  CAS  Google Scholar 

  58. Frick M, Frykman V, Jensen-Urstad M et al (2001) Factors predicting success rate and recurrence of atrial fibrillation after first electrical cardioversion in patients with persistent atrial fibrillation. Clin Cardiol 24:238–244

    Article  PubMed  CAS  Google Scholar 

  59. Lafuente-Lafuente C, Mouly S, Longas-Tejero MA et al (2009) Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. The Cochrane Library 2009, Issue 1

  60. AFFIRM First Antiarrhythmic Drug Substudy Investigators (2003) Maintenance of sinus rhythm in patients with atrial fibrillation: an AFFIRM substudy of the first antiarrhythmic drug. J Am Coll Cardiol 42(1):20–29

    Article  Google Scholar 

  61. Touboul P, Brugada J, Capucci A et al (2003) Dronedarone for prevention of atrial fibrillation: a dose-ranging study. Eur Heart J 24(16):1481–1487

    Article  PubMed  CAS  Google Scholar 

  62. Singh BN, Connolly SJ, Crijns HJ, EURIDIS and ADONIS Investigators et al (2007) Dronedarone for maintenance of sinus rhythm in atrial fibrillation or flutter. N Engl J Med 357(10):987–-999

  63. Hohnloser SH, Crijns HJ, van Eickels M, ATHENA Investigators et al (2009) Effect of dronedarone on cardiovascular events in atrial fibrillation. N Engl J Med 360(7):668–678

    Google Scholar 

  64. Le Heuzey JY, De Ferrari GM, Radzik D et al (2010) A short-term, randomized, double-blind, parallel-group study to evaluate the efficacy and safety of dronedarone versus amiodarone in patients with persistent atrial fibrillation: the DIONYSOS study. J Cardiovasc Electrophysiol 21(6):597–605

    Article  PubMed  Google Scholar 

  65. Connolly SJ, Camm AJ, Halperin JL, PALLAS Investigators et al (2011) Dronedarone in high-risk permanent atrial fibrillation. N Engl J Med 365(24):2268–2276

    Google Scholar 

  66. Kober L, Torp-Pedersen C, McMurray JJ, Dronedarone Study Group et al (2008) Increased mortality after dronedarone therapy for severe heart failure. N Engl J Med 358(25):2678–2687

    Google Scholar 

  67. Podda GM, Casazza G, Casella F et al (2012) Addressing the management of atrial fibrillation—a systematic review of the role of dronedarone. Int J Gen Med 5:465–478

    PubMed  CAS  Google Scholar 

  68. Wann LS, Curtis AB, ACCF/AHA/HRS (2011) Focused update on the management of patients with atrial fibrillation (updating the 2006 guideline). Circulation 123:104–123

  69. Buccelletti F, Di Somma S, Galante A et al (2011) Disparities in management of new-onset atrial fibrillation in the emergency department despite adherence to the current guidelines: data from a large metropolitan area. Intern Emerg Med 6:149–156

    Article  PubMed  Google Scholar 

  70. Moskop JC, Sklar DP, Geiderman JM et al (2009) Emergency department crowding. Ann Emerg Med 53:605–617

    Article  PubMed  Google Scholar 

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Tampieri, A., Rusconi, A.M. & Lenzi, T. Cardioversion in atrial fibrillation. Focus on recent-onset atrial fibrillation. Intern Emerg Med 7 (Suppl 3), 241–250 (2012). https://doi.org/10.1007/s11739-012-0863-0

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