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Introduction: PVI is an effective, guideline-based treatment for drug refractory symptomatic AF. Balloon cryoablation has been shown to be a safe and effective method for PVI. In the STOP-AF trial, data was produced from practitioners performing PVI with significant experience at high volume centers. This study evaluates the effectiveness and safety of treating symptomatic, drug refractory AF with PVI via cryoablation after implementation in a regional medical center. Method: This represents a retrospective analysis of outcomes after cryoablation treatment for AF in 71 patients over 354.7 +/- 164.4 days. Reported and recorded episodes of AF were categorized into a representative percent of AF "burden" for each 90 day period. Primary effectiveness and safety end points paralleled those of the STOP-AF trial. Results: Patients undergoing cryoablation had a 91% reduction of AF burden at 6 months following the procedure with an event-free survival rate of 45.5 % at a mean follow up of 12 months. The mean burden reduction was 3.21% per quarter. Anti-arrhythmic and anticoagulant medication use was reduced by 14.3% and 26.8% respectively. Significant complications included one report of pulmonary vein stenosis, one report of pseudoaneurysm and 5.5% of patients had transient pericarditis or pericardial effusion following the procedure. Conclusion: The results of this study were comparable to those of the high volume multi-center STOP-AF trial. PVI via cryoablation is a safe and effective alternative treatment of drug refractory symptomatic AF in the setting of a regional medical center. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is the most common arrhythmia and is a major cardiovascular challenge due to its close association with increased morbidity and mortality. Although the incidence and prevalence of AF is slightly lower in developing countries than in developed countries, the AF-associated risk of stroke is similar. Treatment of AF is far from satisfactory in developing countries, which may be due to limited health-care resources and social and racial characteristics that differ from Western populations. Chronic rate control is still the main treatment strategy of persistent AF because anti-arrhythmic drugs have only a modest long-term effect on maintenance of sinus rhythm, and no superior impact in terms of cardiovascular outcomes. With the development of ablation techniques and strategies, more AF patients received catheter ablation, although the benefit, complications, and high recurrence rate associated with AF ablation remain under investigation. Improvement in antithrombotic therapy of AF has been observed, although still fewer patients receive oral anticoagulants in developing countries than in Western countries. Novel treatment for the prevention of thromboembolism, such as new oral anticoagulants with different mechanisms of action or the percutaneous transcatheter closure of the left atrial appendage, has recently been introduced in developing countries as an alternative option for the prevention of AF-associated strokes. More data are needed regarding upstream therapy. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is the most common cardiac arrhythmia in the general population and in patients with a history of cardiovascular disease. AF is becoming an outbreak particularly for the western countries as it increases with advancing age; furthermore, AF has a negative social impact because it is associated with stroke and myocardial infarction. Thrombosis generated in the left atrial appendage with ensuing embolism in the cerebral circulation is considered the most important cause of ischemic stroke. In addition to thrombo-embolism, AF is characterized by a constellation of atherosclerotic risk factors, including hypertension, dyslipidaemia and diabetes, which may predispose to serious clinical complications of atherosclerosis such myocardial infarction. Even if interventional trials with oral anticoagulants such as warfarin reduced by about 60% the risk of stroke, AF patients still disclose an elevated residual cardiovascular risk, which may severely complicate the clinical course and management of AF. Recent trials with new oral anticoagulants (NOACs) are opening a new scenario for the treatment of AF, which could improve its management, as NOACs apparently would not require monitoring. However, important caveats are emerging in the real world of AF management, which are questioning the concept that NOACs do not need monitoring. Thus, issues related to compliance and large variability in blood concentration may negatively influence the cost/effectiveness benefit of NOACs. This review will focus on pathophysiology of thrombo-embolism and athero-thrombosis and the impact of old and new anticoagulants in the real world of AF management. [ABSTRACT FROM AUTHOR]

Catheter ablation is widely used to treat drug-refractory, symptomatic atrial fibrillation (AF). However, beyond pulmonary vein isolation, there remains little consensus on the recommended approach to ablation both in paroxysmal or persistent AF patients. Although ancillary ablation strategies are often used, the lack of a clear endpoint for AF ablation makes it challenging to evaluate their importance. Noninducibility and termination of AF during AF ablation have been advocated as potential endpoints. Several studies have attempted to assess their role in an AF ablation protocol. However, the data for non-inducibility and termination as endpoints are mixed. Moreover, there are a number of limitations in the studies reported and limitations of the endpoints themselves. It is likely that non-inducibility or termination of AF during AF ablation may be markers of less structural remodeling rather than true endpoints for ablation. Herein, we review the relevant literature on the topic of inducibility and termination with respect to AF ablation and attempt to draw conclusions with guidance to further investigation. [ABSTRACT FROM AUTHOR]

Endocardial catheter ablation is a widely used alternative for the treatment of atrial fibrillation (AF). Despite technical improvements, and increased understanding of mechanism, and acquired technical experience over many years, the results are not yet optimal. This results in an ongoing search for new therapeutic approaches. Because cardiac sympathetic drive is potentially responsible for triggering and sustaining AF, modulation of sympathetic tone has been proposed as a viable treatment objective. The early attempts to test this concept were limited by nature=highly intrusive techniques but new approaches and targets have been recently introduced. Specifically, renal nerve ablation has been introduced and the first attempts to employ this technique for treatment of cardiac arrhythmias give as a promise of new therapeutic avenues in near future. This review focuses on the possible role of renal denervation in treatment of atrial fibrillation, the contemporary evidence supporting this approach, and the ongoing trials to establish its therapeutic role. [ABSTRACT FROM AUTHOR]

Atrial fibrillation has evolved from being a novel unproven procedure to being an important treatment option for patients with symptomatic atrial fibrillation. Atrial fibrillation ablation is an appropriate treatment option for patients with symptomatic atrial fibrillation, particularly if they have failed one or more trials of antiarrhythmic drug therapy. While much has been learned about the optimal technique and outcomes for catheter ablation of paroxysmal atrial fibrillation; catheter ablation of atrial fibrillation in patients with long standing persistent atrial fibrillation remains in its infancy. The following objectives would be accomplished in this review article. First, we will review the various ablation strategies, which have been employed and proposed for ablation of long standing persistent atrial fibrillation. Second, the methodology, results and outcomes of the major studies were reviewed in detail, which have reported outcomes of ablation in this patient population. And finally, some conclusions were drawn regarding where we stand and where the knowledge gaps remain as we seek to improve ablation outcomes in this population of AF patients. [ABSTRACT FROM AUTHOR]

In patients with recurrent atrial fibrillation (AF), the hallmark of treatment has been the use of antiarrhythmic drugs (AADs). Goals of therapy include reduction in the frequency and duration of episodes of arrhythmia as well an emerging goal of reducing mortality and hospitalizations associated with AF. Safety and efficacy are important factors when choosing an antiarrhythmic drug for the treatment of AF, hence, if AAD are required for maintenance of sinus rhythm, their safety profi le, together with individual patient characteristics, should be of utmost concern. In the next paragraphs we would like to review some aspects (electrophysiologic effects, metabolism, side effects, current evidence and indication) of the most commonly used AAD for the management of patients with AF, following the Vaughan-Williams classification. However, this system is mainly based on ventricular activity, therefore, and due to its relatively atrial selective actions, some agents will not readily fit in the Vaughan Williams AAD classification. For that reason, in the final part of the manuscript, new promising agents will be reviewed separately. [ABSTRACT FROM AUTHOR]

Atrial Fibrillation (AF) is the most common clinically significant sustained cardiac arrhythmia, a major risk factor for strokes whether it is symptomatic or silent. The older CHADS2 score and the newer CHA2DS2-VASc are well validated to determine stroke risk and guide initiation of antithrombotic therapy, but haemorrhagic risk has to be respected as well, and scores such as HAS-BLED should be widely used. Old fashioned warfarin became standard of care outperforming antiplatelets in every trial but novel classes of anticoagulants that overcome many of warfarin drawbacks have been introduced and are already guideline recommended regiments. Nevertheless their use poses new questions that have to been answered in the near future. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is a common disorder associated with significant morbidities and presents several challenges for the control of symptoms and prevention of long-term implications. Atrial defibrillators (ADs), used for rhythm control in patients with symptoms refractory to medical therapy, can detect recurrences of the arrhythmia, allow prompt patient-directed treatment, and have the potential to reduce hospitalizations and improve quality of life. The efficacy of this form of therapy is highest in patients with paroxysmal AF, and with the use of a coronary sinus shocking lead. While R-wave synchronized shocks are a prerequisite for a safe use, the procedure is well tolerated and usually not associated with long-term psychological side effects. Limitations of ADs include acute and chronic complications related to cardiac rhythm device implantation, the requirement in some cases for more than one shock to terminate AF, the discomfort from shocks, as well as the need for sedation to alleviate pain from the shocks. With the ever-expanding role of catheter-based therapies for AF, it seems that the role of ADs in this regard is rather limited. [ABSTRACT FROM AUTHOR]

The article presents a study that investigates ways on how to control the rates of atrial fibrillation (AF) and prevent morbidity in patients in the U.S. It offers information on the role of increase heart rates in the morbidity of patients with AF. It presents the efficacy of using anti-arrhythmics and sinus rhythm in controlling AF. It features the medical tools used by doctor to control patients' morbidity and the benefits of controlling the AF morbidity rates. Moreover, the different clinical trials done by researchers andt its results are also mentioned.

Background: Ablation for atrial fibrillation (AF) is a widely-accepted treatment for this arrhythmia. Ablation is traditionally reserved for second-line therapy in patients who have failed drug therapy, but it may be ready for first-line treatment. Objective: This article outlines the rationale for using ablation as first-line therapy for AF. Findings: AF increases both morbidity and mortality. Unfortunately, drug-based therapy for AF is very ineffective and may contribute adversely to both patient morbidity and mortality. Ablation addresses the root causes of AF and thus may be curative. The technique for ablation has become quite consistent and the outcomes better than those with drug therapy. The complication risk is also acceptably low. There is even preliminary evidence to suggest that AF ablation is superior as first-line treatment compared to drugs. Conclusion: AF ablation is rapidly evolving towards becoming first-line therapy for some patients with this debilitating arrhythmia. [ABSTRACT FROM AUTHOR]

Background: To identify and characterise pre-procedural and procedural parameters which predict maintenance of sinus rhythm after a first circumferential pulmonary vein isolation (CPVI) for recurrent atrial fibrillation (AF). Methods: 100 patients (54±10 yrs) undergoing CARTO-guided CPVI for symptomatic drug refractory, paroxysmal or shortstanding persistent AF were studied. The endpoint was complete electrical isolation within the encircled regions. 3D left atrial (LA) volume was measured by CARTO geometry. Follow-up examinations (symptoms, ECG, 24-hour ECG recording) were performed at 1 and 3 months and every 3 months thereafter. Results: After the first CPVI, 71 patients (71%) were free of AF without antiarrhythmic drug therapy (follow up:28±11 months). The only independent and significant predictors for freedom of AF after the first CPVI were duration of AF history and 3D LA volume (p<0.05). However, a significant overlap in durations of AF history and 3D LA volumes between failures and successes was observed. Conclusions: (1) Using the "circumferential pulmonary vein isolation" approach, the first catheter ablation leads to resolution of arrhythmia in ≈ 70% of symptomatic AF patients. (2) Independent predictors for freedom of AF after initial CPVI are duration of AF history and 3D LA volume. (3) Due to considerable overlap between failures and successes, these parameters can not be used to identify patients who should not undergo CPVI or in whom an additional ablation beyond CPVI is required. On the other hand, our results do suggest that an ablation strategy early in the course of AF disease can influence successful outcome. [ABSTRACT FROM AUTHOR]

Lithium overdose primarily results in neurologic toxicity; however a number of important cardiac side effects have previously been reported, including nonspecific T-wave changes, ST-segment changes, QTc prolongation, sinus node dysfunction, atrioventricular blocks and ventricular dysrhythmias. Atrial fibrillation due to such toxicity is very uncommon. The current paper describes a patient who developed acute atrial fibrillation due to chronic lithium overdose. [ABSTRACT FROM AUTHOR]