Atrial Fibrillation: Pertinent to Practitioners

Abstract

With increasing longevity and decreased mortality of cardiovascular diseases, atrial fibrillation (AF) has emerged as one of the important public health problems. AF is the most common sustained cardiac arrhythmia, the prevalence of which increases with age. Prevalence of AF is approximately 3% in adults aged 20 years or older. It complicates almost all cardiac diseases sooner or later producing not only symptomatic deterioration but sharply increasing morbidity and mortality. Although a simple bedside ECG has remained the gold standard in the diagnosis of this arrhythmia for more than a century, advances in Echocardiography, advanced imaging techniques and electrophysiology have greatly facilitated the assessment of the underlying cardiac pathophysiologic state. Presentation of AF may vary from palpitation to a disabling embolism, the prevention of which is of paramount importance. Management approaches of AF are broadly based on heart rate control, restoration to sinus rhythm and anti-coagulation to prevent a thrombus formation. Oral anti-coagulation (OAC) with vitamin K antagonists significantly reduce stroke rate. The recent availability of newer oral anti-coagulants (NOACs) has increased the safety and efficacy of OAC. Development of clinical scoring systems for assessing the risk of thrombosis and bleeding, such as CHA2DS2VASC and HAS-BLED scores, has greatly aided in decision making for giving or withholding OAC. Similarly, therapeutic advances like catheter ablation and left atrial appendage occlusion have immensely improved the outcome of patients suffering from AF which otherwise have a poor prognosis. Key Words: Arrhythmia, Stroke, oral anticoagulants, Vitamin K antagonist, NOAC.