These pathways can be eliminated by ablation techniques in the electrophysiology laboratory. Tachycardia can be a normal response to exercise, this is known as sinus tachycardia. The heart rate will race simply because of the exercise. Another form of tachycardia, a potentially life-threatening form, is known as ventricular tachycardia.
It is when the lower chambers of the heart are racing rapidly. Yes, you can take additional medication but is very important to realize that the medicines that are available for atrial fibrillation can interact with each other in a bad way.
One reason to take additional medicines would be to try to stop the rhythm. Fleconaide and Propafenone, two antiarrhythmic medications are sometimes prescribed to be taken only when the rhythm occurs.
This would be safe as long as these medications are indicated for that specific individual they would not be for an underlying heart condition and you should never mix two antiarrhythmic medications.
Sometimes medications which are given, are given specifically to keep the heart rate under control. If the heart rate gets faster, it would be appropriate to take a little extra of these medications. It is unlikely that taking a blood thinner, specifically at the time of the onset of atrial fibrillation, would be of any use. What we have discussed today is the problem of a serious condition known as atrial fibrillation. This common medical problem has many different presentations and associations with other conditions.
There are new advances in therapies, some of which can cure atrial fibrillation, which are being investigated further. Medical therapy often requires multiple adjustments until the proper prescription is achieved for any given individual.
Any therapy that is used for atrial fibrillation has potential risks and must be prescribed on an individualized basis. A "one-size-fits-all" for atrial fibrillation simply does not work.
Newer therapies are being developed at a rapid rate and it is likely that in the next five to ten years, cures for atrial fibrillation will be common and perhaps of lower risk than they are now. Use of Health Topics. What causes atrial fibrillation? Is atrial fibrillation associated with a heart attack or stroke? The risk of blood clots caused by atrial fibrillation increases with the following conditions: Hypertension Heart failure Diabetes Increasing age Will atrial fibrillation ever go away?
There are several important concerns using this number as a benchmark: The procedure is really still new and somewhat experimental. Not all electrophysiologists and not all centers have the expertise to perform this.
The longterm success rate is not clear because the follow-up has been in terms of months rather than years. There may be multiple spots that trigger atrial fibrillation and they might not all be obvious at the time of the evaluation. There are some potential risks of this procedure: one risk includes so-called pulmonary vein stenosis. Is it safe to work out with this condition? Is there a common drug therapy? There are several approaches to atrial fibrillation management with drugs: Drugs to control the heart rate during atrial fibrillation.
Drugs to keep someone in sinus rhythm. Drugs to prevent blood clots that can happen from atrial fibrillation. Can tarantula spider venom treat atrial fibrillation? Can the first symptom of atrial fibrillation be a stroke? Is Digitalis still used to treat an irregular heartbeat? Cardiovascular related hospitalisation in AF patients also significantly predicts risk of death HR 2. Clinical investigations also help to identify patients at increased risk of AF-related averse events.
Serum bio-markers such as interleukin-6, high sensitivity troponin T and von Willebrand factor have been shown to predict all-cause mortality independent of CHADS2 score in anti-coagulated AF patients, possibly reflecting coronary micro-vascular dysfunction, global endothelial dysfunction or athero-thrombosis [ 66 - 68 ].
High sensitivity CRP has also been shown to predict all-cause and cardiovascular mortality amongst AF patients [ 69 ]. Echocardiographic markers such as mitral annular calcification, presence of spontaneous left atrial contrast, severe LV impairment and greater than moderate mitral regurgitation also help to predict increased mortality risk amongst chronic AF patients [ 61 , 71 ].
Several AADs have been shown to cause pro-arrhythmic side-effects and thus increased mortality in patients [ 58 ]. The class I agent flecainide gained particular attention following the CAST trial [ 72 ] where increased mortality was observed in patients with history of myocardial infarction. These results have been extrapolated to extend its contraindication to patients with coronary artery disease, heart failure or left ventricular hypertrophy.
Coplen, in a meta-analysis published in , showed that treatment with quinidine was more effective than no anti-arrhythmic therapy in suppressing recurrences of atrial fibrillation but appeared to be associated with increased total mortality [ 73 ]. Class III medications such as amiodarone and sotalol, have also received similar attention, and are also well known for their risk of QT prolongation and Torsades de Pointes. Indeed all AADs have the potential to have serious, pro-arrhythmic side effects [ 58 ].
This has implications when determining the optimal treatment strategy for atrial fibrillation AF : the restoration and maintenance of sinus rhythm rhythm control strategy or control of heart rate alone rate control strategy. None of these studies has shown any significant difference in all-cause or cardiovascular mortality and stroke outcome between rate and rhythm control and in fact a meta-analysis of five major trials showed a trend towards reduced risk of death rate vs.
This has generally led to the adoption of rate control strategy as the pragmatic approach especially in the elderly or in presence of significant co-morbidities. A retrospective analysis of the cause-specific mortality in the AFFIRM trial showed that the incidence of cardiac including arrhythmic, heart failure and MI deaths and vascular including ischaemic and haemorrhagic strokes deaths was not significantly different between the rhythm control and rate-control groups [ 48 ].
Thus the increased all-cause mortality in the rhythm-control group could be entirely accounted for by the significant difference between the incidences of non-cardiovascular deaths These non-cardiovascular deaths were mainly due to malignancies and pneumonia. This was attributed to earlier discontinuation of warfarin and higher incidence of stroke rather than risk of the anti-arrhythmic itself which highlights the importance of anticoagulation in atrial fibrillation.
However, there has been some evidence demonstrating the benefits of rhythm control particularly in the longer term. The survival benefits of sinus rhythm were similar to that seen in the DIAMOND AF dofetilide versus placebo in AF patients with LV dysfunction study which did not show an all-cause mortality benefit; however, restoration and maintenance of sinus rhythm significantly reduced mortality risk ratio 0.
In a population-based study of rate versus rhythm control strategies among 26, AF patients, showed that the rhythm control group demonstrated a small increase in mortality within six months of treatment initiation which then became similar to mortality in the rate-control group until year 4. In the longer term however after year 5 , the mortality was lower in the rhythm control group in comparison to that in the rate-control group HR 0.
From the above studies, it is likely that the pro-arrhythmic effects and multi-systemic side-effects of existing AADs dilute and even offset the survival advantage provided by maintenance of sinus rhythm. The most commonly used AAD for rhythm control in all these trials was amiodarone, which was shown in the studies to have a low pro-arrhythmic potential, with its adverse side effects being mainly extra-cardiac [ 59 ]. Amiodarone has been demonstrated to be the most efficacious drug in maintaining sinus rhythm [ 59 , 79 ].
Some studies have found it to be associated with an increased risk of non-cardiac mortality particularly cancer-related and pulmonary [ 83 - 85 ] whilst this was not observed in other studies [ 86 , 87 ].
Recently Freemantle et al. A meta-analysis by Piccini et al. More recently, there has been the arrival of dronedarone, an AAD developed to have fewer side effects and improved safety profile compared to amiodarone [ 88 ]. However, subsequent studies have shown that dronedarone can lead to increased early mortality in certain sub-sets of patients.
Effective anticoagulation is the most effective method of reducing mortality in AF patients [ 92 ]. In addition to anti-coagulation with warfarin, it is also important to closely monitor the therapeutic range of INR closely to both prevent thrombo-embolic complications as well as avoid major bleeding complications. Analysis of day mortality due to ischaemic stoke whilst on warfarin, has shown that warfarin significantly reduces 30 day mortality if INR is between OR 0.
Interestingly, in contrast to this predominant view held by most physicians, patients are willing to accept the higher risk of bleeding associated with anti-coagulants in order to avoid disabling strokes which some even view as worse than death [ 97 ].
The search for more efficacious and potentially safer anti-thrombotics has heralded the era of novel anti-coagulants, as detailed below.
In the RELY study [ 98 ], dabigatran, a novel oral direct thrombin inhibitor, given at a dose of mg to AF patients, was associated with rates of stroke and systemic embolism similar to warfarin, but with lower rates of major haemorrhage, whilst at doses of mg, it was associated with lower rates of stroke and systemic embolism compared to warfarin, and similar rates of major haemorrhage. The rates of death from any cause were 4.
There was no significant difference in risk of major bleeding, though intracranial and fatal bleeding occurred less frequently in the rivaroxaban group. There was no significant difference in mortality between the two groups.
The future for these novel anticoagulants is very promising, with significant progress being made in morbidity and mortality reduction compared to warfarin, mainly by way of further reduction in ischaemic strokes and less bleeding risks.
However there are also several concerns regarding the use of the newer anticoagulants as detailed below. Whilst the lack of need to closely monitor anticoagulation whilst on newer anticoagulants can be viewed as an advantage by reducing patient inconvenience as well as the burden on healthcare resources, this feature can also be a disadvantage if patients miss one or more doses due to the short offset time of these drugs leading to a rebound stroke risk.
Additionally the lack of a specific antidote to these drugs is also of concern during major bleeding episodes. Thus there is a need for further studies in order to clarify the above concerns about these drugs before they can be incorporated into widespread clinical practice. Catheter ablation is recommended in the management of symptomatic paroxysmal AF after failed AAD therapy and has not yet been demonstrated to confer mortality benefits possibly due to lack of long-term follow-up data.
Being an invasive procedure, the procedure itself carries a mortality risk of up to 0. However, newer technological developments are consistently improving the safety and efficacy of catheter-based techniques.
Left atrial appendage closure using occlusion devices has been suggested as an alternative for patients deemed unsuitable for oral anti-coagulation and again data on mortality benefits from this procedure is lacking currently. AF and its associated co-morbidities continue to impose a significant mortality risk despite several new therapeutic advances.
Indeed a proportion of the AF-related mortality is caused by side-effects due to attempts at restoring and maintaining sinus rhythm or major bleeding due to anti-coagulation. However effective anti-coagulation is the only therapeutic strategy that has been shown to reduce AF-related mortality and newer anticoagulants with improved efficacy and lesser bleeding side-effects, are only likely to improve the risk-benefit profile. Currently available AADs have limited efficacy and possess significant side-effects which seem to offset benefits of rhythm control; hence there is a pressing need to develop improved AADs in order to unmask the survival benefit that could accrue from maintenance of sinus rhythm.
The impact of catheter ablation in the management of AF has currently been increasing and with improvements in safety and efficacy, is likely to reduce the use of AADs in the future.
The authors confirm that this article content has no conflict of interest. National Center for Biotechnology Information , U. Journal List Curr Cardiol Rev v. Curr Cardiol Rev.
Published online Aug. Fox 3. David J. Author information Article notes Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Abstract Atrial fibrillation AF continues to impose a significant burden upon healthcare resources. Keywords: Atrial fibrillation, arrhythmia, mortality, anti-arrhythmic drugs. AGE Age is a major risk factor for developing AF, and older patients are more likely to have co-morbidities that might impact on survival.
SEX In developed societies, healthy females possess a survival advantage over males [ 17 ]. Non-cardiovascular Deaths Most therapeutic strategies for AF such as anti-arrhythmic drugs, anti-thrombotics and catheter ablation can increase mortality risk in AF as a side-effect or serious adverse event.
References 1. Feinberg W. Stroke Prevention in Atrial Fibrillation Investigators. Relationship between prothrombin activation fragment F1. Camm A. Heart J. Stewart S. Kirchhof P. Outcome parameters for trials in atrial fibrillation: executive summary. Benjamin E. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Vidaillet H. Take care to sidestep these food items if you live with the condition.
New guidelines are recommending newer drugs due to concerns over potential severe bleeding from warfarin use. Atrial fibrillation, or AFib, is an irregular heartbeat arrhythmia that can lead to blood clots, stroke, heart failure, and other heart-related…. Health Conditions Discover Plan Connect. Mental Health. Stroke Heart failure Prevention Share on Pinterest. One complication of AFib: stroke.
Another complication of AFib: heart failure. How you can avoid the complications of atrial fibrillation. Read this next. Medically reviewed by Angelica Balingit, MD.
Medically reviewed by Debra Sullivan, Ph. Medically reviewed by Emelia Arquilla, DO. Figure 1. Open in new tab Download slide. Table 2 Standardized mortality ratios in relation to type of atrial fibrillation and concomitant risks in patients followed 4. AF type. CHADS2 score. All patients. Paroxysmal 17 0. Figure 2. Table 3 Standardized mortality ratios for specific causes of death in relation to type of AF among patients followed from index date in until 31 December Cause of death.
Table 4 Multivariable Cox regression of factors associated with all-cause mortality among patients during a mean follow-up of 4. Crude measures. Adjusted for age and sex. Final model a.
Hazard ratio. Figure 3. Table 5 Standardized mortality ratios in relation to embolic prophylaxis on the latest contact and type of atrial fibrillation in patients followed 4.
Paroxysmal 49 1. Effect of atrial fibrillation pattern on survival in a community-based cohort. Google Scholar Crossref. Search ADS. Predictors and prognosis of paroxysmal atrial fibrillation in general practice in the UK. Long-term prognosis of patients with paroxysmal atrial fibrillation complicating acute myocardial infarction.
Paroxysmal atrial fibrillation coincident with cardiac decompensation is a predictor of poor prognosis in chronic heart failure. The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Factors influencing mortality in atrial fibrillation. Post hoc analysis of an observational study in outpatients. Atrial fibrillation: a risk factor for increased mortality—an AVID registry analysis.
The influence of atrial fibrillation on prognosis in mild to moderate heart failure. Google Scholar PubMed. Stroke prophylaxis in atrial fibrillation: who gets it and who does not? Selecting patients with atrial fibrillation for anticoagulation: stroke risk stratification in patients taking aspirin.
Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation: outcomes from a controlled nonrandomized long-term study. Evaluation of survival and ischaemic and thromboembolic event rates in patients with non-valvar atrial fibrillation in the general population when treated and untreated with warfarin.
The effect of warfarin on mortality and reinfarction after myocardial infarction. All rights reserved. For Permissions, please e-mail: journals. Issue Section:. Download all slides. Supplementary data. AddSuppFiles-6 - ppt file. AddSuppFiles-5 - jpg file. AddSuppFiles-4 - ppt file. AddSuppFiles-3 - jpg file. AddSuppFiles-2 - ppt file.
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