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Anti-Thrombotic Strategies for Patients with Atrial Fibrillation and Heart Failure

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Abstract

Atrial fibrillation occurs commonly in the setting of congestive heart failure and, in fact can cause left ventricular dysfunction due to a rapid ventricular response over time, termed tachycardia-mediated cardiomyopathy. The combination of atrial fibrillation and congestive heart failure leads to a high risk of stroke for the patient and appropriate antithrombotic therapy can minimize this incidence of stroke. Stroke risk can be markedly reduced by treatment with warfarin and complications of anticoagulation minimized by close attention to maintaining the INR between 2.0 and 3.0.

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References

  1. Kannel WB, Abbott RD, Savage DD, et al. Epidemiologic features of chronic atrial fibrillation. The Framingham Study. N Engl J Med1982;306:101–1022.

    Google Scholar 

  2. Ostrander LD Jr, Brandt RL, Kjelsberg MO, Epstein FH. Electrocardiographic findings among the adult population of a total natural community, Tecumseh, Michigan. Circulation1965;31:88–898.

    Google Scholar 

  3. Lake FR, McCall MG, Cullen KJ, et al. Atrial fibrillation and mortality in an elderly population. Aust N Z J Med1989;19:32–326.

    Google Scholar 

  4. Cairns JA, Connolly SJ. Nonrheumatic atrial fibrillation. Circulation1991;84:46–481.

    Google Scholar 

  5. Onundarson PT, Thorgeirsson G, Jonmundsson E, Sigfusson N, Hardson Th. Chronic atrial ibrillation- Epidemiologic features and 14 year follow-up: A case control study. Eur Heart J1987;3:52–527.

    Google Scholar 

  6. Carson PE, Johnson GR, Dunkman WB, et al. The influence of atrial fibriliation on prognosis in mild to moderate heart failure. The V-HeFT studies. Circulation1993;87(suppl VI):VI-10–VI-110.

    Google Scholar 

  7. The SOLVD investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med1991;325:29–302.

    Google Scholar 

  8. Pfeffer MA, Braunwald E, Moye LA, et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the Survival and Ventricular Enlargement trial. N Engl J Med1992;327:66–677.

    Google Scholar 

  9. Middlekauff HR, Stevenson WG, Stevenson LW. Prognostic significance of atrial fibrillation in advanced heart failure. A study of 390 patients. Circulation1991;84:4–48.

    Google Scholar 

  10. Natterson PD, Stevenson WG, Saxon LA, et al. Risk of arterial embolization in 224 patients awaiting cardiac transplantation. Am Heart J1995;129:56–570.

    Google Scholar 

  11. Stevenson WG, Stevenson LW, Middlekauff HR. Improving survival for patients with atrial fibrillation and advanced heart failure. J Am Coll Cardiol1996;28:145–1463.

    Google Scholar 

  12. Mahoney P, Kimmel S, Denofrio D, et al. Prognostic significance of atrial fibrillation in patients at a tertiary medical center reffered for heart transplantation because of severe heart failure. Am J Cardiol1999;83:154–1547.

    Google Scholar 

  13. CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. N Engl J Med1987;316:142–1435.

    Google Scholar 

  14. Naito M, David D, Michelson EL, Schaffenburg M, Dreifus LS. The hemodynamic consequences of cardiac arrythmias: Evaluation of the relative roles of abnormal atrioventricular sequencing, irregularity of ventricular rhythm and atrial fibrillation in a canine model. Am Heart J1983;106:284.

    Google Scholar 

  15. Clark DM, Plumb VJ, Epstein AE, Kay GN. Hemodynamic effects of an irregular sequence of ventricular cycle lengths during atrial fibrillation. J AmColl Cardiol1997;30:103–1045.

    Google Scholar 

  16. Brookes CIO, White PA, Staples M, Oldershaw PJ, Redington AN, Collins PD, Noble MIM. Myocardial contractility is not constant during spontaneous atrial fibrillation in patients. Circulation1998;98:176–1768.

    Google Scholar 

  17. Gosselink ATM, Crijns HJGM, Van Den Berg MP, et al. Functional capacity before and after cardioversion of atrial fibrillation: A controlled study. Br Heart J1994;72:16–166.

    Google Scholar 

  18. Upshaw CB Jr. Hemodynamic changes after cardioversion of chronic atrial fibrillation. Arch Intern Med1997;157:107–1076.

    Google Scholar 

  19. Vanden Berg MP, Tuinenburg AE, van Veldhuisen DJ, de Kam PJ, Crijns HJGM. Cardioversion of atrial fibrillation in the setting of mild to moderate heart failure. International Journal of Cardiology1998;63:6–70.

    Google Scholar 

  20. Prystowsky EN, Katz A. Atrial fibrillation. In: EJ Topol, ed. Textbook of Cardiovascular Medicine. Philadelphia: Lippincott-Raven, 1998.

    Google Scholar 

  21. Packer DL, Bardy GH, Worley SJ, Smith MS, Cobb FR, Coleman RE, Gallagher JJ, German LD. Tachycardiainduced cardiomyopathy: A reversible form of left ventricular dysfunction. Am J Cardiol1986;57:56–570.

    Google Scholar 

  22. Phillips E, Levine SA. Auricular fibrillation without other evidence of heart disease: A cause of reversible heart failure. Am J Med1949;7:47–489.

    Google Scholar 

  23. Grogan M, Smith HC, Gersh BJ, Wood DL. Left ventricular dysfunction due to atrial fibrillation in patients initially believed to have idiopathic dilated cardiomyopathy. Am J Cardiol1992;69:157–1573.

    Google Scholar 

  24. Keiny JR, Sacrez A, Facello A, et al. Increase in radionuclide left ventricular ejection fraction after cardioversion of chronic atrial fibrillation in idiopathic dilated cardiomyopathy. Eur Heart J1992;13:129–1295.

    Google Scholar 

  25. Shinbane JS, Wood MA, Jensen DN, Ellenbogen KA, Fitzpatrick AP, Scheinman MM. Tachycardia-induced cardiomyopathy: A review of animal models and clinical studies. J Amer Coll Cardiol1997;29:70–715.

    Google Scholar 

  26. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation: A major contributor to stroke in the elderly. The Framingham study. Arch Intern Med1987;147:156–1564.

    Google Scholar 

  27. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation is an independent risk factor for stroke: The Framingham study. Stroke1991;22:98–988.

    Google Scholar 

  28. Petersen P, Boysen G, Godtfredsen J, et al. Placebocontrolled, randomised trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation: The Copenhagen AFASAK study. Lancet1989;1:17–178.

    Google Scholar 

  29. The Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators. The effect of low-dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation. N Engl J Med1990;323:1505.

    Google Scholar 

  30. Stroke Prevention in Atrial Fibrillation Investigators. Stroke Prevention in Atrial Fibrillation: Final results. Circulation1991;84:527.

    Google Scholar 

  31. Ezekowitz MD, Bridgers SL, James KE, et al. Warfarin in the prevention of stroke associated with nonrheumatic atrial fibrillation. N Engl J Med1992;327:140–1412.

    Google Scholar 

  32. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation: Analysis of pooled data from five randomized controlled trials. Arch Intern Med1994;154:144–1457.

    Google Scholar 

  33. Prystowsky EN, Benson W, Jr, Fuster V, et al. Management of patients with atrial fibrillation. A statement for healthcare professionals from the subcommittee on electrophysiology, American Heart Association. Circulation1996;93:126–1277.

    Google Scholar 

  34. Miller VT, Rothrock JF, Pearce LA, et al. Ischemic stroke in patients with atrial fibrillation: Effect of aspirin according to stroke mechanism: Stroke Prevention in Atrial Fibrillation Investigators. Neurology1993;43:3–36.

    Google Scholar 

  35. Bogousslavsky J, Van Melle G, Regli F, Kappenberger L. Pathogenesis of anterior circulation stroke in patients with nonvalvular atrial fibrillation: The Lausanne Stroke Registry. Neurology1990;40:104–1050.

    Google Scholar 

  36. Rosenthal MS, Halpern JL. Thromboembolism in nonvalvular atrial fibrillation: The answer may be in the ventricle. Int J Cardiol1992;37:27–282.

    Google Scholar 

  37. Zabalgoitia M, Dipeshkumar KG, McPherson D, Mehlman DJ, Talano JV. Spontaneous echo contrast in severe left ventricular dysfunction: A risk factor for thromboembolism. Circulation1990;82(suppl.3):III-109. Abstract.

    Google Scholar 

  38. The Stroke Prevention in Atrial Fibrillation Investigators.Predictors of thromboembolism in atrial fibrillation, II: Echocardiographic features of patients at risk. Ann Intern Med1992;116:–12.

    Google Scholar 

  39. Blackshear JL, Pearce LA, Asinger RW, et al. Mitral regurgitation associated with reduced thromboembolic events in high-risk patients with nonrheumatic atrial fibrillation. Stroke Prevention in Atrial Fibrillation Investigators. Am J Cardiol1993;72:84–843.

    Google Scholar 

  40. The Stroke Prevention in Atrial Fibrillation Investigators. Predictors of thromboembolism in atrial fibrillation: I. Clinical features of patients at risk. Ann Intern Med1992;116:–5.

    Google Scholar 

  41. Segal JP, Stapleton JF, McClellan JR, et al. Idiopathic cardiomyopathy: Clinical features, prognosis and therapy. Curr Prob Cardiol1978;3:–49.

    Google Scholar 

  42. Cioffi G, Pozzoli M, Forni G, et al. Systemic thromboembolism in chronic heart failure. Eur Heart J1996;17:138–1389.

    Google Scholar 

  43. Dunkman WB, Johnson GR, Carson PE, et al. Incidence of thromboembolic events in congestive heart failure. Circulation1993;87(suppl. IV):VI-9–VI-101.

    Google Scholar 

  44. Connolly SJ, Laupacis A, Gent M, et al. Canadian Atrial Fibrillation Anticoagulation (CAFA) study. J Amer Coll Cardiol1991;18:349.

    Google Scholar 

  45. EAFT Study Group. European Atrial Fibrillation Trial: Secondary prevention of vascular events in patients with non-rheumatic atrial fibrillation and a recent transient ischaemic attack or minor ischaemic stroke. Lancet1993;342:125–1262.

    Google Scholar 

  46. Stroke Prevention in Atrial Fibrillation Investigators. Adjusted-dose warfarin versus low-intensity, fixed-dose warfarin plus aspirin for high risk patients with atrial fibrillation: Stroke prevention in atrial fibrillation III randomized clinical trial. Lancet1996;348:63–638.

    Google Scholar 

  47. Hylek EM, Skates SJ, Sheehan MA, Singer DE. An analysis of the lowest effective intensity of prophylactic anticoagulation for patients with nonrheumatic arial fibrillation. N Engl J Med1996;335:54–546.

    Google Scholar 

  48. Prystowsky EN. Management of atrial fibrillation: Therapeutic options and clinical decisions. Am J Cardiol2000;85:3D-11D.

    Google Scholar 

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Authors
  1. Mary Norine Walsh
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  2. Eric N. Prystowsky
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Walsh, M.N., Prystowsky, E.N. Anti-Thrombotic Strategies for Patients with Atrial Fibrillation and Heart Failure. Heart Fail Rev 7, 261–266 (2002). https://doi.org/10.1023/A:1020081327269

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