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Clinical Management of Atrial Fibrillation

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Cardiac Arrhythmias, Pacing and Sudden Death

Part of the book series: Cardiovascular Medicine ((CVM))

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Abstract

Clinical care of patients with atrial fibrillation (AF) is complex and highly individualized. The initial assessment of a patient with AF centers on determination of AF type (paroxysmal or persistent), burden, symptoms, and risk for thromboembolism and stroke. Treatment strategies can then be selected focusing on rate vs. rhythm control and stroke risk reduction. Rate control is typically achieved with medical therapy, but AV junctional ablation and pacing are appropriate in selected patients. Rhythm control may involve cardioversion, antiarrhythmic drug therapy, catheter or surgical ablation, and, for some patients, a combination of these therapies. Stroke prevention has traditionally focused primarily on anticoagulation with warfarin, but novel oral anticoagulants and mechanical closure of the left atrial appendage now offer alternative approaches. A thorough understanding of the risks and benefits of all of these treatment approaches, as well as of the clinical status and preferences of each patient, is necessary to provide optimal individualized care to patients with AF.

Disclosures: E.K.H. (all modest in amount): Biotronik (research grant, honoraria), Boston Scientific (research grant, consultant, honoraria), Janssen (consultant), Medtronic (honoraria), Sorin (consultant, honoraria), St. Jude Medical (research grant, consultant, honoraria).M.M.: Biosense Webster (consultant, research grant), St Jude medical (consultant, research grant), Medtronic (consultant), Boston Scientific (consultant), Biotronik (consultant), Pfizer (research grant), Boehringer Ingelheim (research grant).J.N.R.: Advanced Medical Education (Consultant); Cardiome (Consultant); Daiichi Sankyo (Consultant); Gilead Sciences (Data Monitoring Committee); InfoBionic (Scientific Advisory Board/Equity); Laguna Medical (Data Monitoring Committee); Medtronic (Scientific Advisory Board); Portola Pharmaceuticals (Consultant/Equity).

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Author information

Authors and Affiliations

  1. Cardiac Arrhythmia Service and Heart Center, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., GRB 109, Boston, MA, 02114, USA

    E. Kevin Heist M.D., Ph.D., Moussa Mansour M.D. & Jeremy N. Ruskin M.D.

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  1. E. Kevin Heist M.D., Ph.D.
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  2. Moussa Mansour M.D.
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  3. Jeremy N. Ruskin M.D.
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Corresponding author

Correspondence to Jeremy N. Ruskin M.D. .

Editor information

Editors and Affiliations

  1. Lankenau Heart Institute and Jefferson Medical College, Philadelphia, Pennsylvania, USA

    Peter Kowey

  2. Associate Professor of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina, USA

    Jonathan P. Piccini

  3. Bernard Trabin Chair in Cardiology Professor of Medicine Chief, Division of Cardiology, Associate Clinical Director Heart and Vascular Institute, Penn State University College of Medicine, Hershey, Pennsylvania, USA

    Gerald Naccarelli

  4. Professor Emeritus of Medicine Department of Medicine, Division of Cardiology, Section of Electrophysiology, Columbia University, New York, USA

    James A. Reiffel

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Kevin Heist, E., Mansour, M., Ruskin, J.N. (2017). Clinical Management of Atrial Fibrillation. In: Kowey, P., Piccini, J., Naccarelli, G., Reiffel, J. (eds) Cardiac Arrhythmias, Pacing and Sudden Death. Cardiovascular Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-58000-5_15

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  • DOI: https://doi.org/10.1007/978-3-319-58000-5_15

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-57998-6

  • Online ISBN: 978-3-319-58000-5

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