370:(Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile International Normalized Ratio, Elderly, Drugs/alcohol concomitantly) bleeding risk schema as a simple, easy calculation, whereby a score of β₯3 indicates "high risk" and some caution and regular review of the patient is needed. The HAS-BLED score has also been validated in an anticoagulated trial cohort of 7329 patients with AF β in this study, the HAS-BLED score offered some improvement in predictive capability for bleeding risk over previously published bleeding risk assessment schemas and was simpler to apply. With the likely availability of new oral anticoagulants that avoid the limitations of warfarin (and may even be safer), more widespread use of oral anticoagulation therapy for stroke prevention in AF is likely.
812:) in 1987. "Maze" refers to the series of incisions made in the atria, which are arranged in a maze-like pattern. The intention was to eliminate AF by using incisional scars to block abnormal electrical circuits (atrial macroreentry) that AF requires. This procedure required an extensive series of endocardial (from the inside of the heart) incisions through both atria, a median sternotomy (vertical incision through the breastbone) and cardiopulmonary bypass (heart-lung machine). A series of improvements were made, culminating in 1992 in the Cox maze III procedure, which is now considered to be the "gold standard" for effective surgical cure of AF. The Cox maze III is sometimes referred to as the "traditional maze", the "cut and sew maze", or simply the "maze".
779:
antiarrhythmic medication. In 27.3% of patients, more than one procedure was required to attain these results. There was at least one major complication in 6% of patients. Death has been found to occur in 1 in 1000 people who undergo this procedure. A thorough discussion of results of catheter ablation was published in 2007; it notes that results are widely variable, due in part to differences in technique, follow-up, definitions of success, use of antiarrhythmic therapy, and in experience and technical proficiency.
140:(LAF), characterized by absence of clinical or echocardiographic findings of other cardiovascular disease (including hypertension), related pulmonary disease, or cardiac abnormalities such as enlargement of the left atrium, and age under 60 years . The incidence of stroke associated with AF is 3 to 5 percent per year in the absence of anticoagulation, which is significantly higher compared to the general population without AF (relative risk 2.4 in men and 3.0 in women). A
921:"ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society"
634:(blood clot) from the previously fibrillating left atrium. Cardioversion should not be performed without adequate anticoagulation in patients with more than 48 hours or unknown duration of AF. Anticoagulation is adequate if warfarin is given with target INR between 2 and 3 for three to four weeks prior to cardioversion, and continued for at least four weeks after cardioversion. Cardioversion may be performed in instances of AF lasting more than 48 hours if a
149:) and on the presence of other risk factors, such as diabetes and high blood pressure. Finally, patients under 65 are much less likely to develop embolization compared with patients over 75. In young patients with few risk factors and no structural heart defect, the benefits of anticoagulation may be outweighed by the risks of
363:
older data, there is now greater recognition of the importance of good anticoagulation control (as reflected by time in therapeutic range) as well as greater awareness of bleeding risk factors as well as data from recent trials that aspirin carries a similar rate of major bleeding to warfarin, especially in the elderly.
97:. The primary factors determining AF treatment are duration and evidence of circulatory instability. Cardioversion is indicated with new onset AF (for less than 48 hours) and with circulatory instability. If rate and rhythm control cannot be maintained by medication or cardioversion, it may be necessary to perform
566:
The AFFIRM study showed no difference in risk of stroke in patients who have converted to a normal rhythm with antiarrhythmic treatment, compared to those who have only rate control. AF is associated with a reduced quality of life, and while some studies indicate that rhythm control leads to a higher
144:
of risk factors for stroke in patients with nonvalvular AF concluded that a prior history of stroke or TIA is the most powerful risk factor for future stroke, followed by advancing age, hypertension, and diabetes. For patients with LAF, the risk of stroke is very low and is independent of whether the
443:
An attempt was made to find a better method of implementing warfarin therapy without the inconvenience of regular monitoring and risk of intracranial hemorrhage. A combination of aspirin and fixed-dose warfarin (initial INR 1.2β1.5) was tried. Unfortunately, in a study of AF patients with additional
476:
Very elderly (patients aged 75 years or more) may benefit from anticoagulation provided that their anticoagulation does not increase hemorrhagic complications, which is a difficult goal. Patients aged 80 years or more may be especially susceptible to bleeding complications, with a rate of
742:
In patients with AF where rate control drugs are ineffective and it is not possible to restore sinus rhythm using cardioversion, non-pharmacological alternatives are available. For example, to control rate it is possible to destroy the bundle of cells connecting the upper and lower chambers of the
562:
seeks to restore with cardioversion the regular heart rhythm and maintain it with drugs. Studies suggest that rhythm control is mainly a concern in newly diagnosed AF, while rate control is more important in the chronic phase. Rate control with anticoagulation is as effective a treatment as rhythm
403:
In cases of chronic stable AF without any other risk factors for thromboembolism, the
Seventh American College of Chest Physicians (ACCP) Conference on Antithrombotic and Thrombolytic Therapy recommends initiating warfarin without heparin bridging. While there is a theoretical concern of causing a
117:
A: Avoid stroke with
Anticoagulation, where the default is stroke prevention unless the patient is at low risk. Stroke prevention means use of oral anticoagulation (OAC), whether with well managed vitamin K antagonists (VKA), with time in therapeutic range >70%, or more commonly, label-adherent
362:
To compensate for the increased risk of stroke, anticoagulants may be required. However, in the case of warfarin, if someone with AF has a yearly risk of stroke that is less than 2%, then the risks associated with taking warfarin outweigh the risk of getting a stroke from AF. However, since these
3475:
Calkins H, Brugada J, Packer DL, Cappato R, Chen SA, Crijns HJ, Damiano RJ Jr, Davies DW, Haines DE, Haissaguerre M, Iesaka Y, Jackman W, Jais P, Kottkamp H, Kuck KH, Lindsay BD, Marchlinski FE, McCarthy PM, Mont JL, Morady F, Nademanee K, Natale A, Pappone C, Prystowsky E, Raviele A, Ruskin JN,
3476:
Shemin RJ (2007). "HRS/EHRA/ECAS expert
Consensus Statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation".
1992:
Mant J, Hobbs FD, Fletcher K, Roalfe A, Fitzmaurice D, Lip GY, Murray E (August 2007). "BAFTA investigators; Midland
Research Practices Network (MidReC). Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation
337:
score, the ESC guidelines on atrial fibrillation management recommend using the new CHA2DS2-VASc score (Congestive heart failure, Hypertension, Age β₯75 years (doubled), Diabetes mellitus, Stroke (doubled), Vascular disease, Age 65β74 years, Sex category], which is more inclusive of 'stroke risk
213:
score is a well-validated simple clinical prediction rule for determining the risk of stroke (and therefore who should and should not be anticoagulated with warfarin); it assigns points (totaling 0β6) depending on the presence or absence of co-morbidities such as hypertension and diabetes. In a
841:
The Ex-Maze is a minimally invasive procedure, first reported in 2007, that also creates a lesion pattern across both atria epicardially on the beating heart. As with other procedures off-bypass, the surgeon can confirm that AF corrects to normal sinus rhythm during the procedure. Laparoscopic
751:
instead. This "ablate and pace" technique has an important place in the treatment of AF< as it is the only reliably effective method for relieving the symptoms of the arrhythmia and can be used when other methods have failed (as they do in up to 50% of cases of persistent AF). Although this
778:
Efficacy and risks of catheter ablation of AF are areas of active debate. A worldwide survey of the outcomes of 8745 ablation procedures demonstrated a 52% success rate (ranging from 14.5% to 76.5% among centers), with an additional 23.9% of patients becoming asymptomatic with addition of an
327:
More recently, the 2010 European
Society of Cardiology (ESC) guidelines have recommended a risk factor based approach to stroke prevention, and de-emphasised the artificial stratification into low/moderate/high risk, given the poor predictive value of these 3 categories. To complement the
2169:"Comparative Validation of a Novel Risk Score for Predicting Bleeding Risk in Anticoagulated Patients With Atrial Fibrillation: The HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) Score"
842:
instruments are used to access the pericardium through the diaphragm. Like many heart-cauterizing instruments, the Ex-Maze device uses heat generated by a radiofrequency coil. The coil is inside a plastic tube that uses suction to maintain contact against the beating heart's surface.
774:
inserted into veins in the groin or neck. Electrodes that can detect electrical activity from inside the heart are also inserted, and the electrophysiologist uses these to "map" an area of the heart to locate the abnormal electrical activity before eliminating the responsible tissue.
729:
The anti-arrhythmic medications often used in either pharmacological cardioversion or in the prevention of relapse to AF alter the flux of ions in heart tissue, making them less excitable, setting the stage for spontaneous and durable cardioversion. The agents work by prolonging the
645:
within one year, although the continued daily use of oral antiarrhythmic drugs may extend this period. The key risk factor for relapse is duration of AF, although other risk factors that have been identified include the presence of structural heart disease, and old age.
341:
The most recent validation study used nationwide data on 73,538 hospitalized non-anticoagulated patients with AF in
Denmark, whereby in 'low risk' subjects (score=0), the rate of thromboembolism per 100 person-years was 1.67 (95% confidence interval 1.47 to 1.89) with
2444:
Connolly S, Pogue J, Hart R, et al. (2006). "Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation
Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial".
791:
is associated with increased risk of atrial fibrillation. The mechanism for this paradoxical association is uncertain, but one hypothesis is the stabilizing effect of cholesterol on myocardial cell membranes. Another possibility is lipoproteins binding to bacterial
467:
inhibitor, and does not require blood tests for INR monitoring, while offering similar results in terms of efficacy in the treatment of non-valvular AF. The place of the new thrombin inhibitor class of drugs in the treatment of chronic AF is still being worked out.
338:
modifier' risk factors. The new CHA2DS2-VASc score (Congestive heart failure, Hypertension, Age β₯75 years (doubled), Diabetes mellitus, Stroke (doubled), Vascular disease, Age 65β74 years, Sex category] has also been validated in other large independent cohorts.
1732:
Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ (February 2010). "Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation".
570:
A further study focused on rhythm control in patients with AF and simultaneous heart failure, based on the premise that AF entails a higher mortality risk in heart failure. In this setting, too, rhythm control offered no advantage compared to rate control.
3847:
Jia, X; Gao, F; Pickett, JK; Al Rifai, M; Birnbaum, Y; Nambi, V; Virani, SS; Ballantyne, CM (August 2021). "Association
Between Omega-3 Fatty Acid Treatment and Atrial Fibrillation in Cardiovascular Outcome Trials: A Systematic Review and Meta-Analysis".
346:
and 0.78 (0.58 to 1.04) with CHA2DS2-VASc score, at 1 year follow-up. Thus, those categorised as 'low risk' using CHA2DS2-VASc score were 'truly low risk' for thromboembolism, and consistent with other cohorts, CHA2DS2-VASc score performed better than
2999:
Crystal E, Lamy A, Connolly SJ, et al. (2003). "Left Atrial
Appendage Occlusion Study (LAAOS): a randomized clinical trial of left atrial appendage occlusion during routine coronary artery bypass graft surgery for long-term stroke prevention".
420:
reduced the risk of stroke by 25%, but increased the risk of major bleeding by 57%, which means that this combination is inferior to warfarin, and is not an alternative for patients who are judged to be at high risk of bleeding on warfarin therapy.
3035:
Healey JS, Crystal E, Lamy A, et al. (2005). "Left Atrial
Appendage Occlusion Study (LAAOS): results of a randomized controlled pilot study of left atrial appendage occlusion during coronary bypass surgery in patients at risk for stroke".
702:
In addition to these agents, amiodarone has some AV node blocking effects (particularly when administered intravenously), and can be used in individuals when other agents are contraindicated or ineffective (particularly due to hypotension).
2876:
Mant J, et al. (2007). "Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial".
2036:
Hindricks, Gerhard; Potpara, Tatjana; Dagres, Nikolaos; Arbelo, Elena; Bax, Jeroen J.; BlomstrΓΆm-Lundqvist, Carina; Boriani, Giuseppe; Castella, Manuel; Dan, Gheorghe-Andrei; Dilaveris, Polychronis E.; Fauchier, Laurent (29 August 2020).
512:, the source of blood clots in more than 90% of cases. A trial comparing closure against warfarin therapy found closure to be non-inferior when measured against a composite end point of stroke, cardiovascular death and systemic embolism.
428:(INR), often referred to by clinicians as "pro-time"; this determines whether the correct dose is being used. In AF, the usual target INR is between 2.0 and 3.0 (a higher target, INR between 2.5 and 3.5, is used in patients with prior
1003:
Romiti, Giulio Francesco; Pastori, Daniele; Rivera-Caravaca, JosΓ© Miguel; Ding, Wern Yew; Gue, Ying X; Menichelli, Danilo; Gumprecht, Jakub; Koziel, Monika; Yang, Pil-Sung; Guo, Yutao; Lip, Gregory YH; Proietti, Marco (21 May 2021).
145:
LAF was an isolated episode, paroxysmal, persistent, or permanent. The risk of systemic embolization (atrial clots migrating to other organs) depends strongly on whether there is an underlying structural problem with the heart (e.g.
2408:
Aguilar M, Hart R, Pearce L (2007). Aguilar MI (ed.). "Oral anticoagulants versus antiplatelet therapy for preventing stroke in patients with non-valvular atrial fibrillation and no history of stroke or transient ischemic attacks".
444:
risk factors for thromboembolism, the combination of aspirin and the lower dose of warfarin was significantly inferior to the standard adjusted-dose warfarin (INR 2.0β3.0), yet still had a similar risk of intracranial hemorrhage.
2955:
Holmes DR, Reddy VY, Turi ZG, et al. (2009). "Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial".
654:
Rate control is achieved with medications that work by increasing the degree of block at the level of the AV node, effectively decreasing the number of impulses that conduct down into the ventricles. This can be done with:
1492:"Factors associated with ischemic stroke during aspirin therapy in atrial fibrillation: analysis of 2012 participants in the SPAF I-III clinical trials. The Stroke Prevention in Atrial Fibrillation (SPAF) Investigators"
3349:
Siu CW, Lau CP, Lee WL, Lam KF, Tse HF (2009). "Intravenous diltiazem is superior to intravenous amiodarone or digoxin for achieving ventricular rate control in patients with acute uncomplicated atrial fibrillation".
2096:
Pisters R, Lane DA, Nieuwlaat R, De Vos CB, Crijns HJ, Lip GY (2010). "A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey".
1164:
Pastori, Daniele; Pignatelli, Pasquale; Menichelli, Danilo; Violi, Francesco; Lip, Gregory Y.H. (July 2019). "Integrated Care Management of Patients With Atrial Fibrillation and Risk of Cardiovascular Events".
2789:
Merli G, Spyropoulos AC, Caprini JA (August 2009). "Use of emerging oral anticoagulants in clinical practice: translating results from clinical trials to orthopedic and general surgical patient populations".
543:, angina, lassitude (weariness), and decreased exercise tolerance are related to rapid heart rate and inefficient cardiac output caused by AF. Furthermore, AF with a persistent rapid rate can cause a form of
121:
B: Better symptom and atrial fibrillation management with patient-centred, symptom directed decisions on rate control or rhythm control. In some selected patients, use early rhythm control may be beneficial.
463:. The approval came after an advisory committee recommended the drug for approval on 20 September 2010 although caution is still urged by reviewers. Dabigatran is an anticoagulant that works as a direct
2573:"Adjusted-dose warfarin versus low-intensity, fixed-dose warfarin plus aspirin for high-risk patients with atrial fibrillation: Stroke Prevention in Atrial Fibrillation III randomised clinical trial"
721:
The mainstay of maintaining sinus rhythm is the use of antiarrhythmic agents. Recently, other approaches have been developed that promise to decrease or eliminate the need for antiarrhythmic agents.
734:(ERP) either by blocking sodium ions (Class I drugs) or by blocking potassium ions (Class III drugs) or a mixture of both. These medications are often used in concert with electrical cardioversion.
3285:
Singer DE, Albers GW, Dalen JE, et al. (2008). "Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)".
3893:"Effect of Long-Term Marine Ι·-3 Fatty Acids Supplementation on the Risk of Atrial Fibrillation in Randomized Controlled Trials of Cardiovascular Outcomes: A Systematic Review and Meta-Analysis"
128:
An integrated management approach, which includes stroke prevention, symptoms control and management of associated comorbidities has been associated with better outcomes in patients with AF.
1115:"Comprehensive Management With the ABC (Atrial Fibrillation Better Care) Pathway in Clinically Complex Patients With Atrial Fibrillation: A Post Hoc Ancillary Analysis From the AFFIRM Trial"
831:(heart-lung machine). They use laser, cryothermy, radiofrequency, or acoustic energy to ablate atrial tissue near the pulmonary veins and make other required ablations to mimic the maze.
2920:
Fountain RB, Holmes DR, Chandrasekaran K, et al. (2006). "The PROTECT AF (WATCHMAN Left Atrial Appendage System for Embolic PROTECTion in Patients with Atrial Fibrillation) trial".
78:
may be employed to decrease the risk of stroke. Within the context of stroke, the discipline may be referred to as stroke prevention in atrial fibrillation (SPAF). In emergencies, when
2328:
Zeuthen EL, Lassen JF, Husted SE (2003). "Is there a hypercoagulable phase during initiation of antithrombotic therapy with oral anticoagulants in patients with atrial fibrillation?".
1695:
Sanders, Gillian D.; Lowenstern, Angela; Borre, Ethan; Chatterjee, Ranee; Goode, Adam; Sharan, Lauren; LaPointe, Nancy M. Allen; Raitz, Giselle; Shah, Bimal (30 October 2018).
1426:
Sanders, Gillian D.; Lowenstern, Angela; Borre, Ethan; Chatterjee, Ranee; Goode, Adam; Sharan, Lauren; LaPointe, Nancy M. Allen; Raitz, Giselle; Shah, Bimal (30 October 2018).
1208:
Sanders, Gillian D.; Lowenstern, Angela; Borre, Ethan; Chatterjee, Ranee; Goode, Adam; Sharan, Lauren; LaPointe, Nancy M. Allen; Raitz, Giselle; Shah, Bimal (30 October 2018).
94:
416:
Among patients with nonvalvular AF, anticoagulation with warfarin can reduce stroke by 60% while antiplatelet agents can reduce stroke by 20%. The combination of aspirin and
3777:
Kiser AC, Wimmer-Greinecker G, Kapelak B, Bartus K, Streitman JS, Knaut M, Sadowski J (2008). "Achieving Metrics during Beating Heart Ex-Maze Procedures Improves Outcomes".
752:
procedure results in a regular (paced) heart rhythm it does not prevent the atria from fibrillating and therefore long-term warfarin anticoagulation may still be required.
2039:"2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS)"
1056:
113:
Contemporary AF management emphasises a more holistic or integrated care approach, which is summed up as the ABC (Atrial fibrillation Better Care) pathway, as follows:
440:, many of whom may also have AF). A high INR may indicate increased bleeding risk, while a low INR would indicate that there is insufficient protection from stroke.
3666:
3205:
Onalan O, Crystal E, Daoulah A, Lau C, Crystal A, Lashevsky I (2007). "Meta-analysis of magnesium therapy for the acute management of rapid atrial fibrillation".
1391:
Kopecky SL, Gersh BJ, McGoon MD, et al. (10 September 1987). "The natural history of lone atrial fibrillation. A population-based study over three decades".
397:
197:
1778:"Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC)"
1313:
Frost, L; Engholm, G; Johnsen, S; MΓΈller, H; Husted, S (2000). "Incident stroke after discharge from the hospital with a diagnosis of atrial fibrillation".
1057:"Improved Outcomes by Integrated Care of Anticoagulated Patients with Atrial Fibrillation Using the Simple ABC (Atrial Fibrillation Better Care) Pathway"
321:
Increase INR to 2.0β3.0, unless contraindicated (e.g., history of falls, clinically significant GI bleeding, inability to obtain regular INR screening)
3812:
Kiser AC, Nifong LW, Raman J, Kasirajan V, Campbell N, Chitwood Jr WR (2008). "Evaluation of a Novel Epicardial Atrial Fibrillation Treatment System".
2365:
Hart RG, Pearce LA, Aguilar MI (2007). "Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation".
1348:
Stroke Risk in Atrial Fibrillation Working Group (2007). "Independent predictors of stroke in patients with atrial fibrillation: a systematic review".
1863:"Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: nationwide cohort study"
1718:
1451:
1861:
Olesen JB, Lip GY, Hansen ML, Hansen PR, Tolstrup JS, Lindhardsen J, Selmer C, Ahlehoff O, Olsen AM, Gislason GH, Torp-Pedersen C (January 2011).
388:
In the initial stages after an embolic stroke, anticoagulation may be risky, as the damaged area of the brain is relatively prone to bleeding (
385:
or similar drugs achieve the required level of protection much quicker than warfarin, which will take several days to reach adequate levels.
1533:"A risk score for predicting stroke or death in individuals with new-onset atrial fibrillation in the community: the Framingham Heart Study"
558:
seeks to reduce the heart rate to one that is closer to normal, usually 60 to 100 bpm, without trying to convert to a regular rhythm.
762:(RFA) uses radiofrequency energy to destroy abnormal electrical pathways in heart tissue. Other energy sources include laser, cryothermy,
3240:
Singh BN, Connolly SJ, Crijns HJ, et al. (2007). "Dronedarone for maintenance of sinus rhythm in atrial fibrillation or flutter".
758:(AF ablation) is a method that increasingly is used to treat cases of recurrent AF that are unresponsive to conventional treatments.
137:
3074:
Wyse DG, Waldo AL, DiMarco JP, Domanski MJ, Rosenberg Y, Schron EB, Kellen JC, Greene HL, Mickel MC, Dalquist JE, Corley SD (2002).
404:
transient prothrombotic state with the initiation of warfarin, a study comparing the initiation of warfarin alone with warfarin and
2293:
Ansell J, Hirsh J, Poller L, Bussey H, Jacobson A, Hylek E (2004). "The Pharmacology and Management of the Vitamin K Antagonists".
1776:
Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar N, Hindricks G, et al. (October 2010).
578:
significantly increases the chances of successful rate and rhythm control in the urgent setting without significant side-effects.
355:
and 0.888 (0.875 to 0.900) with CHA2DS2-VASc, respectively β and suggests that CHA2DS2-VASc score also performed better than CHADS
1656:"Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation"
424:
Warfarin treatment requires frequent (usually monthly) monitoring with a blood test resulting in a standardized number known as
2251:"Efficacy and safety of anticoagulant treatment in acute cardioembolic stroke: a meta-analysis of randomized controlled trials"
124:
C: Cardiovascular risk factor and comorbidity management, including attention to lifestyle factors and psychological morbidity.
551:. This can significantly increase mortality and morbidity, which can be prevented by early and adequate treatment of the AF.
2837:"Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation"
858:
concluded that more than 1 g/d marine omega-3 fatty acids is associated with an increased risk of atrial fibrillation (AF).
827:
but without cardiac incisions. These procedures do not require a median sternotomy (vertical incision in the breastbone) or
408:
shows no significant difference in the concentrations of endogenous anticoagulants or in markers of active clot formation.
838:) maze procedures are now routinely conducted at hospitals around the US. This approach was developed in the early 2000s.
2672:
2132:
Lip GY (2010). "Implications of the CHA(2)DS(2)-VASc and HAS-BLED Scores for Thromboprophylaxis in Atrial Fibrillation".
3689:
1615:"Selecting patients with atrial fibrillation for anticoagulation: stroke risk stratification in patients taking aspirin"
808:
is an open-heart surgical procedure intended to eliminate AF and was first performed at St. Louis' Barnes Hospital (now
3954:
548:
351:
in identifying these 'low risk' patients. The c-statistics at 10 years follow-up were 0.812 (0.796 to 0.827) with CHADS
59:
2762:
2488:
ACTIVE Investigators; Connolly, SJ; Pogue, J; Hart, RG; Hohnloser, SH; Pfeffer, M; Chrolavicius, S; Yusuf, S (2009).
1233:"Long-term progression and outcomes with aging in patients with lone atrial fibrillation: a 30-year follow-up study"
3959:
1231:
Jahangir A, Lee V, Friedman PA, Trusty JM, Hodge DO, Kopecky SL, Packer DL, Hammill SC, Shen WK, Gersh BJ (2007).
1953:"Cost-effectiveness of preference-based antithrombotic therapy for patients with nonvalvular atrial fibrillation"
1822:"A comparison of risk stratification schema for stroke in 79884 atrial fibrillation patients in general practice"
1113:
Proietti, Marco; Romiti, Giulio Francesco; Olshansky, Brian; Lane, Deirdre A.; Lip, Gregory Y. H. (18 May 2020).
524:
493:
589:
is a noninvasive conversion of an irregular heartbeat to a normal heartbeat using electrical or chemical means:
1696:
1427:
1209:
635:
297:
3714:
161:
in those who are allergic to aspirin). In contrast, those with a high risk of stroke derive most benefit from
477:
13 bleeds per 100 person-years. This bleed rate would seem to preclude use of warfarin; however, a
2747:
2743:
2717:
448:
405:
174:
3395:"Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation"
93:
Patients can be classified, based on how much they are limited during physical activity, according to the
3393:
Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, Kim YH, Klein G, Packer D, Skanes A (2005).
731:
478:
393:
1912:"Oral anticoagulants vs aspirin in nonvalvular atrial fibrillation: an individual patient meta-analysis"
960:
Lip, Gregory Y. H. (November 2017). "The ABC pathway: an integrated approach to improve AF management".
1006:"Adherence to the 'Atrial Fibrillation Better Care' (ABC) Pathway in Patients with Atrial Fibrillation"
875:
Prystowsky EN (2000). "Management of atrial fibrillation: therapeutic options and clinical decisions".
389:
98:
2281:
366:
Latest ESC guidelines on atrial fibrillation recommend assessment of bleeding risk in AF using the
201:
2210:"Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study"
3522:
2767:
2664:
1574:"Can patients at elevated risk of stroke treated with anticoagulants be further risk stratified?"
788:
759:
677:
596:
involves the restoration of normal heart rhythm through the application of a DC electrical shock.
497:
485:
of 50. However, this study had very low rate of hemorrhagic complications in the warfarin group.
433:
373:
AF in the context of mitral stenosis is associated with a seventeenfold increase in stroke risk.
102:
3329:"Atrial fibrillation: national clinical guideline for management in primary and secondary care"
828:
809:
482:
437:
400:
recommends that anticoagulation should begin two weeks after stroke if no hemorrhage occurred.
222:
3328:
136:
Most patients with AF are at increased risk of stroke. The possible exceptions are those with
2378:
763:
744:
509:
554:
There are two ways to approach these symptoms using drugs: rate control and rhythm control.
1712:
1614:
1445:
748:
79:
153:(bleeding). Those at a low risk may benefit from mild (and low-risk) anticoagulation with
8:
2330:
460:
316:
291:
54:
3930:
3917:
3892:
3873:
3642:
3617:
3593:
3568:
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3517:
3411:
3394:
3375:
3310:
3187:
2981:
2902:
2817:
2602:
2554:
2470:
2390:
2267:
2250:
2018:
1887:
1862:
1758:
1631:
1373:
1361:
1190:
1141:
1114:
1095:
985:
824:
805:
691:
3908:
3076:"A comparison of rate control and rhythm control in patients with atrial fibrillation"
2969:
2890:
2853:
2836:
2589:
2572:
2542:
2458:
2343:
2006:
1326:
1249:
1232:
937:
920:
888:
3934:
3922:
3877:
3865:
3829:
3825:
3794:
3759:
3754:
3737:
3681:
3647:
3633:
3598:
3549:
3493:
3457:
3416:
3367:
3302:
3267:
3222:
3179:
3138:
3097:
3053:
3017:
2973:
2937:
2894:
2858:
2809:
2699:
2645:
2594:
2546:
2511:
2462:
2426:
2382:
2347:
2310:
2272:
2231:
2190:
2149:
2114:
2078:
2070:
2010:
1974:
1933:
1892:
1843:
1838:
1821:
1799:
1750:
1677:
1636:
1595:
1554:
1513:
1467:
1408:
1365:
1330:
1295:
1254:
1182:
1146:
1087:
1037:
977:
942:
892:
851:
141:
26:
3436:"Prevalence and causes of fatal outcome in catheter ablation of atrial fibrillation"
3379:
3314:
3191:
2906:
2821:
2606:
2558:
2474:
2394:
2022:
1762:
1377:
1194:
1099:
989:
709:
Drugs used to control the rate of AF may cause side effects, especially fatigue and
3912:
3904:
3857:
3821:
3786:
3749:
3637:
3629:
3588:
3580:
3539:
3531:
3485:
3447:
3406:
3359:
3294:
3257:
3249:
3214:
3169:
3128:
3087:
3045:
3009:
2985:
2965:
2929:
2886:
2848:
2801:
2689:
2681:
2635:
2584:
2538:
2501:
2454:
2422:
2418:
2374:
2339:
2306:
2302:
2262:
2221:
2180:
2141:
2106:
2060:
2050:
2002:
1964:
1923:
1882:
1874:
1833:
1789:
1742:
1700:
1667:
1626:
1585:
1544:
1503:
1431:
1400:
1357:
1322:
1285:
1244:
1213:
1174:
1136:
1126:
1079:
1071:
1027:
1017:
969:
932:
884:
520:
425:
3218:
1697:
Stroke Prevention in Patients With Atrial Fibrillation: A Systematic Review Update
1428:
Stroke Prevention in Patients With Atrial Fibrillation: A Systematic Review Update
1210:
Stroke Prevention in Patients With Atrial Fibrillation: A Systematic Review Update
3363:
3133:
3116:
2805:
2721:
2145:
1590:
1573:
1178:
1075:
713:. These are avoided by the more radical "ablate and pace" treatment (see below).
706:
Diltiazem has been shown to be more effective than either digoxin or amiodarone.
516:
501:
429:
146:
75:
3667:"A completely endoscopic approach to microwave ablation for atrial fibrillation"
3489:
2055:
2038:
1404:
1347:
481:
found benefit in treating patients 75 years or over against aspirin with a
3891:
Gencer, B; Djousse, L; Al-Ramady, OT; Cook, NR; Manson, JE; Albert, CM (2021).
3861:
3452:
3435:
2640:
2621:
2185:
2168:
1794:
1777:
1274:"Duration of atrial fibrillation and imminence of stroke: The Framingham Study"
173:(DOACs). Currently, there are four DOACs approved for stroke prevention by the
3158:"Rhythm control versus rate control for atrial fibrillation and heart failure"
3049:
2933:
2529:
Verheugt FWA (2009). "Who is ineligible for warfarin in atrial fibrillation".
973:
3948:
2074:
1969:
1952:
1928:
1911:
1672:
1655:
1508:
1491:
855:
659:
586:
544:
170:
162:
87:
1549:
1532:
1290:
1273:
1131:
3926:
3869:
3833:
3798:
3790:
3763:
3685:
3602:
3584:
3553:
3497:
3461:
3420:
3371:
3306:
3271:
3226:
3183:
3142:
3117:"Quality of life in patients with atrial fibrillation: a systematic review"
3101:
3057:
3021:
2977:
2941:
2898:
2862:
2813:
2744:"FDA approves Pradaxa to prevent stroke in people with atrial fibrillation"
2703:
2649:
2550:
2515:
2466:
2430:
2386:
2351:
2314:
2276:
2194:
2153:
2118:
2082:
2014:
1937:
1896:
1847:
1803:
1754:
1704:
1681:
1640:
1599:
1558:
1517:
1436:
1369:
1334:
1258:
1217:
1186:
1150:
1091:
1055:
Proietti, M; Romiti, GF; Olshansky, B; Lane, DA; Lip, GYH (November 2018).
1041:
981:
946:
896:
611:
540:
528:
3664:
3651:
3535:
3298:
3174:
3157:
2685:
2598:
2506:
2489:
2226:
2209:
2110:
1978:
1746:
1412:
1299:
3253:
3092:
3075:
2626:
2235:
1654:
Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ (2001).
641:
Whichever method of cardioversion is used, approximately 50% of patients
619:
607:
417:
330:
215:
206:
186:
158:
83:
3618:"An 8 1/2-year clinical experience with surgery for atrial fibrillation"
3518:"Relationship between lipoproteins, thrombosis, and atrial fibrillation"
3013:
2694:
2065:
1022:
1005:
41:
3262:
1032:
835:
667:
663:
623:
603:
452:
178:
150:
71:
31:
1083:
2663:
Connolly, SJ; Ezekowitz, MD; Yusuf, S; et al. (September 2009).
2487:
1993:
Treatment of the Aged Study, BAFTA): a randomised controlled trial".
1878:
793:
767:
685:
681:
615:
575:
3738:"Totally extracardiac maze procedure performed on the beating heart"
108:
3776:
2792:
1469:
820:
771:
755:
671:
631:
464:
455:("Pradaxa," and other names) on 19 October 2010, for prevention of
367:
287:
190:
182:
166:
67:
381:
If anticoagulation is required urgently (e.g. for cardioversion),
271:
325 mg/day although lower doses may be similarly efficacious
2665:"Dabigatran versus warfarin in patients with atrial fibrillation"
710:
698:) β have limited use, apart from in the sedentary elderly patient
695:
642:
505:
382:
266:
154:
1694:
1425:
1207:
1163:
1002:
2662:
2490:"Effect of clopidogrel added to aspirin in atrial fibrillation"
1490:
Hart RG, Pearce LA, McBride R, Rothbart RM, Asinger RW (1999).
456:
63:
3735:
2835:
Hylek EM, Evans-Molina C, Shea C, Henault LE, Regan S (2007).
1468:
National Institute for Health and Clinical Excellence (2006).
95:
European Heart Rhythm Association score of atrial fibrillation
3665:
Saltman, AE; LS Rosenthal; NA Francalancia; SJ Lahey (2003).
1820:
Van Staa TP, Setakis E, Di Tanna GL, Lane DA, Lip GY (2010).
1699:(Report). Agency for Healthcare Research and Quality (AHRQ).
1430:(Report). Agency for Healthcare Research and Quality (AHRQ).
1212:(Report). Agency for Healthcare Research and Quality (AHRQ).
630:
The main risk of cardioversion is systemic embolization of a
567:
quality of life, the AFFIRM study did not find a difference.
74:
and rhythm are principally used to achieve the former, while
2919:
2834:
2035:
766:, and high intensity ultrasound. The energy emitting probe (
515:
The left atrial appendage can also be surgically amputated,
300:
to 2.0β3.0, depending on factors such as patient preference
3474:
2248:
1819:
1653:
1112:
1054:
823:
procedures are minimally invasive versions of the original
3890:
3615:
2095:
574:
In patients with a fast ventricular response, intravenous
563:
control in long term mortality studies, the AFFIRM Trial.
3811:
1489:
1312:
1230:
638:(TEE) demonstrates no evidence of clot within the heart.
496:
is an experimental alternative to anticoagulants. During
3392:
3073:
1910:
van Walraven C, Hart RG, Singer DE, et al. (2002).
662:(preferably the "cardioselective" beta blockers such as
3204:
2788:
2292:
1991:
1775:
1731:
1613:
Gage BF, van Walraven C, Pearce L, et al. (2004).
523:
simultaneously with other cardiac procedures such as a
2207:
1909:
1612:
228:
The following treatment strategy is based on the CHADS
3846:
3616:
Cox JL, Schuessler RB, Lappas DG, Boineau JP (1996).
3566:
2166:
1860:
1272:
Wolf, PA; Kannel, WB; McGee, DL; et al. (1983).
815:
534:
398:
National Institute for Health and Clinical Excellence
3336:
National Collaborating Centre for Chronic Conditions
3114:
3736:Kiser AC, Wimmer-Greinecker G, Chitwood WR (2007).
3515:
3434:Cappato R, Calkins H, Chen SA, et al. (2009).
3239:
2998:
2718:"Boehringer wins first US OK in blood-thinner race"
2327:
1950:
919:Fuster V, RydΓ©n LE, Cannom DS, et al. (2006).
214:comparison of seven prediction rules, the best was
3715:"Minimally Invasive Atrial Fibrillation Treatment"
3433:
2249:Paciaroni M, Agnelli G, Micheli S, Caso V (2007).
1390:
782:
488:
3284:
3034:
2443:
2407:
2364:
2208:Wolf PA, Dawber TR, Thomas HE, Kannel WB (1978).
1572:Baruch L, Gage BF, Horrow J, et al. (2007).
1531:Wang TJ, Massaro JM, Levy D, et al. (2003).
918:
109:The ABC (Atrial fibrillation Better Care) Pathway
3946:
3156:Roy D, Talajic M, Nattel S, et al. (2008).
3155:
2622:"New oral anticoagulants in atrial fibrillation"
1571:
3717:. Robert Wood Johnson University Hospital. 2008
3569:"Risk Factor Management in Atrial Fibrillation"
3511:
3509:
3507:
3069:
3067:
2954:
2869:
2760:
1951:Gage BF, Cardinalli AB, Owens D (1 June 1998).
1530:
1271:
747:β which regulates heart rate, and to implant a
3516:Ding WY, Protty MB, Davies IG, Lip GH (2022).
914:
912:
910:
908:
906:
716:
539:AF can cause disabling and annoying symptoms.
2167:Lip GY, Frison L, Halperin J, Lane D (2010).
1470:"Clinical Guideline 36 β Atrial fibrillation"
874:
3560:
3504:
3348:
3338:. London: Royal College of Physicians. 2006.
3115:Thrall G, Lane D, Carroll D, Lip GY (2006).
3064:
3028:
2992:
2913:
2828:
2782:
2763:"New Blood-Thinner Recommended by FDA Panel"
2528:
2437:
2401:
2358:
2242:
1717:: CS1 maint: DOI inactive as of July 2024 (
1565:
1524:
1483:
1450:: CS1 maint: DOI inactive as of July 2024 (
1341:
3658:
1384:
1224:
903:
1815:
1813:
411:
221:which performed similarly to the SPAF and
3916:
3753:
3641:
3592:
3573:Arrhythmia & Electrophysiology Review
3567:Brandes A, Smit MD, Van Gelder I (2018).
3543:
3451:
3410:
3261:
3173:
3132:
3091:
2852:
2693:
2639:
2619:
2588:
2505:
2266:
2225:
2184:
2064:
2054:
1968:
1927:
1886:
1837:
1793:
1671:
1630:
1589:
1548:
1507:
1435:
1289:
1248:
1140:
1130:
1119:Journal of the American Heart Association
1031:
1021:
936:
3805:
3321:
2656:
2379:10.7326/0003-4819-146-12-200706190-00007
2201:
1647:
1606:
724:
376:
58:(AF) is focused on preventing temporary
3770:
3729:
3707:
1810:
1463:
1461:
118:dosed direct oral anticoagulant (DOAC).
3947:
2761:Shirley S. Wang (20 September 2010).
770:) is placed into the heart through a
2875:
1458:
737:
359:in predicting 'high risk' patients.
2736:
2710:
2131:
959:
471:
13:
3412:10.1161/01.CIR.0000157153.30978.67
2268:10.1161/01.STR.0000254600.92975.1f
1632:10.1161/01.CIR.0000145172.55640.93
1362:10.1212/01.wnl.0000267275.68538.8d
816:Minimally invasive maze procedures
549:tachycardia-induced cardiomyopathy
535:Rate control versus rhythm control
131:
14:
3971:
3909:10.1161/CIRCULATIONAHA.121.055654
2854:10.1161/CIRCULATIONAHA.106.653048
2748:U.S. Food and Drug Administration
1250:10.1161/CIRCULATIONAHA.106.644484
938:10.1161/CIRCULATIONAHA.106.177292
602:is performed with drugs, such as
449:U.S. Food and Drug Administration
175:U.S. Food and Drug Administration
105:of abnormal electrical pathways.
21:Management of atrial fibrillation
3850:Cardiovascular Drugs and Therapy
3826:10.1016/j.athoracsur.2007.05.061
3755:10.1016/j.athoracsur.2007.08.027
3634:10.1097/00000658-199609000-00003
2134:The American Journal of Medicine
1839:10.1111/j.1538-7836.2010.04085.x
1064:The American Journal of Medicine
581:
82:is imminent due to uncontrolled
3884:
3840:
3628:(3): 267β73, discussion 273β5.
3609:
3468:
3427:
3386:
3342:
3278:
3233:
3198:
3149:
3108:
2948:
2754:
2613:
2565:
2522:
2481:
2321:
2286:
2160:
2125:
2089:
2029:
1985:
1944:
1903:
1854:
1769:
1725:
1688:
1419:
1306:
1265:
783:Avoid excessive lowering of LDL
649:
494:Left atrial appendage occlusion
489:Left atrial appendage occlusion
2423:10.1002/14651858.CD006186.pub2
2307:10.1378/chest.126.3_suppl.204S
1201:
1157:
1106:
1048:
996:
953:
868:
636:transesophogeal echocardiogram
504:) consisting of an expandable
459:in patients with non-valvular
426:international normalized ratio
1:
3219:10.1016/j.amjcard.2007.01.057
2970:10.1016/S0140-6736(09)61343-X
2891:10.1016/S0140-6736(07)61233-1
2590:10.1016/S0140-6736(96)03487-3
2543:10.1016/S0140-6736(09)61471-9
2459:10.1016/S0140-6736(06)68845-4
2344:10.1016/S0049-3848(03)00240-8
2007:10.1016/S0140-6736(07)61233-1
1327:10.1016/S0002-9343(99)00415-5
889:10.1016/S0002-9149(00)00908-5
861:
834:Minimally invasive surgical (
508:frame is introduced into the
200:guidelines recommend using a
3364:10.1097/CCM.0b013e3181a02f56
3134:10.1016/j.amjmed.2005.10.057
2806:10.1097/SLA.0b013e3181ae6dbe
2146:10.1016/j.amjmed.2010.05.007
1591:10.1161/STROKEAHA.106.477133
1179:10.1016/j.mayocp.2018.10.022
1076:10.1016/j.amjmed.2018.06.012
406:low molecular weight heparin
193:(all factor Xa inhibitors).
99:electrophysiological studies
7:
3490:10.1016/j.hrthm.2007.04.005
1405:10.1056/NEJM198709103171104
845:
799:
732:Effective Refractory Period
717:Maintenance of sinus rhythm
479:randomized controlled trial
394:clinical practice guideline
196:In the United Kingdom, the
34:(cardiac electrophysiology)
10:
3976:
3862:10.1007/s10557-021-07204-z
3453:10.1016/j.jacc.2009.02.022
2620:Turpie AG (January 2008).
2411:Cochrane Database Syst Rev
2186:10.1016/j.jacc.2010.09.024
1010:Thrombosis and Haemostasis
390:hemorrhagic transformation
171:direct oral anticoagulants
3955:Cardiac electrophysiology
3358:(7): 2174β79, quiz 2180.
3050:10.1016/j.ahj.2004.09.054
2934:10.1016/j.ahj.2006.02.005
2056:10.1093/eurheartj/ehaa612
974:10.1038/nrcardio.2017.153
962:Nature Reviews Cardiology
38:
25:
20:
2641:10.1093/eurheartj/ehm575
1970:10.1161/01.STR.29.6.1083
1929:10.1001/jama.288.19.2441
1795:10.1093/eurheartj/ehq278
1707:(inactive 22 July 2024).
1673:10.1001/jama.285.22.2864
1509:10.1161/01.STR.30.6.1223
1440:(inactive 22 July 2024).
678:Calcium channel blockers
594:Electrical cardioversion
500:, a device (such as the
248:Anticoagulation Therapy
202:clinical prediction rule
3960:Cardiovascular diseases
3674:The Heart Surgery Forum
3523:Cardiovascular Research
2768:The Wall Street Journal
2750:(FDA). 19 October 2010.
1550:10.1001/jama.290.8.1049
1291:10.1161/01.str.14.5.664
1167:Mayo Clinic Proceedings
1132:10.1161/JAHA.119.014932
796:reducing inflammation.
760:Radiofrequency ablation
498:cardiac catheterization
438:artificial heart valves
434:rheumatic heart disease
412:Chronic anticoagulation
296:Aspirin daily or raise
60:circulatory instability
3791:10.1532/hsf98.20081044
3585:10.15420/aer.2018.18.2
3293:(6 Suppl): 546Sβ592S.
2583:(9028): 633β38. 1996.
2043:European Heart Journal
1705:10.23970/ahrqepccer214
1437:10.23970/ahrqepccer214
1218:10.23970/ahrqepccer214
829:cardiopulmonary bypass
810:Barnes-Jewish Hospital
600:Chemical cardioversion
483:number needed to treat
204:for this purpose. The
181:(thrombin inhibitor),
3299:10.1378/chest.08-0678
3175:10.1056/NEJMoa0708789
2686:10.1056/NEJMoa0905561
2507:10.1056/NEJMoa0901301
2301:(3 Suppl): 204Sβ33S.
2227:10.1212/wnl.28.10.973
2111:10.1378/chest.10-0134
1747:10.1378/chest.09-1584
764:pulsed field ablation
745:atrioventricular node
725:Antiarrhythmic agents
510:left atrial appendage
377:Acute anticoagulation
3440:J. Am. Coll. Cardiol
3254:10.1056/NEJMoa054686
3093:10.1056/NEJMoa021328
1070:(11): 1359β1366.e6.
80:circulatory collapse
3779:Heart Surgery Forum
3536:10.1093/cvr/cvab017
3014:10.1067/mhj.2003.44
2331:Thrombosis Research
1023:10.1055/A-1515-9630
461:atrial fibrillation
315:Warfarin, or other
70:events. Control of
55:atrial fibrillation
3695:on 18 January 2007
1016:(3): aβ1515β9630.
852:systematic reviews
825:Cox maze procedure
806:Cox maze procedure
692:Cardiac glycosides
392:). As a result, a
317:Oral anticoagulant
292:Oral anticoagulant
225:prediction rules.
90:may be indicated.
3903:(25): 1981β1990.
2885:(9586): 493β503.
2724:. 19 October 2010
2453:(9526): 1903β12.
2173:J Am Coll Cardiol
2001:(9586): 493β503.
738:Catheter ablation
436:, and mechanical
325:
324:
312:Moderate or High
142:systematic review
49:
48:
3967:
3939:
3938:
3920:
3888:
3882:
3881:
3844:
3838:
3837:
3809:
3803:
3802:
3774:
3768:
3767:
3757:
3733:
3727:
3726:
3724:
3722:
3711:
3705:
3704:
3702:
3700:
3694:
3688:. Archived from
3671:
3662:
3656:
3655:
3645:
3613:
3607:
3606:
3596:
3564:
3558:
3557:
3547:
3513:
3502:
3501:
3472:
3466:
3465:
3455:
3446:(19): 1798β803.
3431:
3425:
3424:
3414:
3390:
3384:
3383:
3346:
3340:
3339:
3333:
3325:
3319:
3318:
3282:
3276:
3275:
3265:
3237:
3231:
3230:
3202:
3196:
3195:
3177:
3153:
3147:
3146:
3136:
3127:(5): 448.e1β19.
3112:
3106:
3105:
3095:
3071:
3062:
3061:
3032:
3026:
3025:
2996:
2990:
2989:
2964:(9689): 534β42.
2952:
2946:
2945:
2917:
2911:
2910:
2873:
2867:
2866:
2856:
2832:
2826:
2825:
2786:
2780:
2779:
2777:
2775:
2758:
2752:
2751:
2740:
2734:
2733:
2731:
2729:
2714:
2708:
2707:
2697:
2669:
2660:
2654:
2653:
2643:
2617:
2611:
2610:
2592:
2569:
2563:
2562:
2537:(9689): 510β11.
2526:
2520:
2519:
2509:
2485:
2479:
2478:
2441:
2435:
2434:
2405:
2399:
2398:
2362:
2356:
2355:
2325:
2319:
2318:
2290:
2284:
2282:ACP JC synopsis
2280:
2270:
2246:
2240:
2239:
2229:
2205:
2199:
2198:
2188:
2164:
2158:
2157:
2129:
2123:
2122:
2093:
2087:
2086:
2068:
2058:
2033:
2027:
2026:
1989:
1983:
1982:
1972:
1948:
1942:
1941:
1931:
1907:
1901:
1900:
1890:
1879:10.1136/bmj.d124
1858:
1852:
1851:
1841:
1826:J Thromb Haemost
1817:
1808:
1807:
1797:
1788:(19): 2369β429.
1773:
1767:
1766:
1729:
1723:
1722:
1716:
1708:
1692:
1686:
1685:
1675:
1651:
1645:
1644:
1634:
1610:
1604:
1603:
1593:
1569:
1563:
1562:
1552:
1528:
1522:
1521:
1511:
1487:
1481:
1480:
1478:
1476:
1465:
1456:
1455:
1449:
1441:
1439:
1423:
1417:
1416:
1388:
1382:
1381:
1345:
1339:
1338:
1310:
1304:
1303:
1293:
1269:
1263:
1262:
1252:
1228:
1222:
1221:
1205:
1199:
1198:
1173:(7): 1261β1267.
1161:
1155:
1154:
1144:
1134:
1110:
1104:
1103:
1061:
1052:
1046:
1045:
1035:
1025:
1000:
994:
993:
957:
951:
950:
940:
916:
901:
900:
872:
787:Excessively low
472:Elderly patients
235:
234:
84:rapid heart rate
42:edit on Wikidata
18:
17:
3975:
3974:
3970:
3969:
3968:
3966:
3965:
3964:
3945:
3944:
3943:
3942:
3889:
3885:
3845:
3841:
3814:Ann Thorac Surg
3810:
3806:
3775:
3771:
3742:Ann Thorac Surg
3734:
3730:
3720:
3718:
3713:
3712:
3708:
3698:
3696:
3692:
3669:
3663:
3659:
3614:
3610:
3565:
3561:
3514:
3505:
3473:
3469:
3432:
3428:
3391:
3387:
3347:
3343:
3331:
3327:
3326:
3322:
3283:
3279:
3242:N. Engl. J. Med
3238:
3234:
3213:(12): 1726β32.
3203:
3199:
3168:(25): 2667β77.
3154:
3150:
3113:
3109:
3086:(23): 1825β33.
3072:
3065:
3033:
3029:
2997:
2993:
2953:
2949:
2918:
2914:
2874:
2870:
2847:(21): 2689β96.
2833:
2829:
2787:
2783:
2773:
2771:
2759:
2755:
2742:
2741:
2737:
2727:
2725:
2722:Thomson Reuters
2716:
2715:
2711:
2680:(12): 1139β51.
2667:
2661:
2657:
2618:
2614:
2571:
2570:
2566:
2527:
2523:
2500:(20): 2066β78.
2486:
2482:
2442:
2438:
2417:(3): CD006186.
2406:
2402:
2363:
2359:
2338:(5β6): 241β46.
2326:
2322:
2291:
2287:
2247:
2243:
2206:
2202:
2165:
2161:
2130:
2126:
2105:(5): 1093β100.
2094:
2090:
2034:
2030:
1990:
1986:
1949:
1945:
1922:(19): 2441β48.
1908:
1904:
1859:
1855:
1818:
1811:
1774:
1770:
1730:
1726:
1710:
1709:
1693:
1689:
1666:(22): 2864β70.
1652:
1648:
1625:(16): 2287β92.
1611:
1607:
1570:
1566:
1529:
1525:
1488:
1484:
1474:
1472:
1466:
1459:
1443:
1442:
1424:
1420:
1393:N. Engl. J. Med
1389:
1385:
1346:
1342:
1311:
1307:
1270:
1266:
1243:(24): 3050β56.
1229:
1225:
1206:
1202:
1162:
1158:
1125:(10): e014932.
1111:
1107:
1059:
1053:
1049:
1001:
997:
968:(11): 627β628.
958:
954:
931:(7): e257β354.
917:
904:
883:(10A): 3Dβ11D.
873:
869:
864:
848:
818:
802:
789:LDL cholesterol
785:
740:
727:
719:
652:
584:
537:
502:Watchman device
491:
474:
451:(FDA) approved
430:thromboembolism
414:
379:
358:
354:
350:
345:
334:
309:
280:
260:
251:Considerations
241:
231:
219:
210:
165:treatment with
147:mitral stenosis
134:
132:Anticoagulation
111:
76:anticoagulation
45:
12:
11:
5:
3973:
3963:
3962:
3957:
3941:
3940:
3883:
3856:(4): 793β800.
3839:
3804:
3785:(4): E237β42.
3769:
3748:(5): 1783β85.
3728:
3706:
3657:
3608:
3579:(2): 118β127.
3559:
3530:(3): 716β731.
3503:
3467:
3426:
3405:(9): 1100β05.
3385:
3352:Crit. Care Med
3341:
3320:
3277:
3248:(10): 987β99.
3232:
3207:Am. J. Cardiol
3197:
3148:
3107:
3063:
3027:
2991:
2947:
2912:
2868:
2827:
2781:
2753:
2735:
2709:
2655:
2612:
2564:
2521:
2480:
2436:
2400:
2373:(12): 857β67.
2367:Ann Intern Med
2357:
2320:
2285:
2241:
2220:(10): 973β77.
2200:
2159:
2124:
2088:
2049:(5): 373β498.
2028:
1984:
1963:(6): 1083β91.
1943:
1902:
1853:
1809:
1768:
1724:
1687:
1646:
1605:
1584:(9): 2459β63.
1564:
1543:(8): 1049β56.
1523:
1502:(6): 1223β29.
1482:
1457:
1418:
1399:(11): 669β74.
1383:
1340:
1305:
1264:
1223:
1200:
1156:
1105:
1047:
995:
952:
902:
866:
865:
863:
860:
847:
844:
817:
814:
801:
798:
784:
781:
739:
736:
726:
723:
718:
715:
700:
699:
689:
675:
651:
648:
628:
627:
597:
583:
580:
560:Rhythm control
536:
533:
525:maze procedure
490:
487:
473:
470:
413:
410:
378:
375:
356:
352:
348:
343:
332:
323:
322:
319:
313:
310:
305:
302:
301:
294:
284:
281:
276:
273:
272:
269:
264:
261:
256:
253:
252:
249:
246:
243:
239:
229:
217:
208:
133:
130:
126:
125:
122:
119:
110:
107:
53:management of
47:
46:
39:
36:
35:
29:
23:
22:
9:
6:
4:
3:
2:
3972:
3961:
3958:
3956:
3953:
3952:
3950:
3936:
3932:
3928:
3924:
3919:
3914:
3910:
3906:
3902:
3898:
3894:
3887:
3879:
3875:
3871:
3867:
3863:
3859:
3855:
3851:
3843:
3835:
3831:
3827:
3823:
3820:(1): 300β03.
3819:
3815:
3808:
3800:
3796:
3792:
3788:
3784:
3780:
3773:
3765:
3761:
3756:
3751:
3747:
3743:
3739:
3732:
3716:
3710:
3691:
3687:
3683:
3680:(3): E38β41.
3679:
3675:
3668:
3661:
3653:
3649:
3644:
3639:
3635:
3631:
3627:
3623:
3619:
3612:
3604:
3600:
3595:
3590:
3586:
3582:
3578:
3574:
3570:
3563:
3555:
3551:
3546:
3541:
3537:
3533:
3529:
3525:
3524:
3519:
3512:
3510:
3508:
3499:
3495:
3491:
3487:
3484:(6): 816β61.
3483:
3479:
3471:
3463:
3459:
3454:
3449:
3445:
3441:
3437:
3430:
3422:
3418:
3413:
3408:
3404:
3400:
3396:
3389:
3381:
3377:
3373:
3369:
3365:
3361:
3357:
3353:
3345:
3337:
3330:
3324:
3316:
3312:
3308:
3304:
3300:
3296:
3292:
3288:
3281:
3273:
3269:
3264:
3259:
3255:
3251:
3247:
3243:
3236:
3228:
3224:
3220:
3216:
3212:
3208:
3201:
3193:
3189:
3185:
3181:
3176:
3171:
3167:
3163:
3159:
3152:
3144:
3140:
3135:
3130:
3126:
3122:
3118:
3111:
3103:
3099:
3094:
3089:
3085:
3081:
3077:
3070:
3068:
3059:
3055:
3051:
3047:
3044:(2): 288β93.
3043:
3039:
3031:
3023:
3019:
3015:
3011:
3008:(1): 174β78.
3007:
3003:
2995:
2987:
2983:
2979:
2975:
2971:
2967:
2963:
2959:
2951:
2943:
2939:
2935:
2931:
2928:(5): 956β61.
2927:
2923:
2916:
2908:
2904:
2900:
2896:
2892:
2888:
2884:
2880:
2872:
2864:
2860:
2855:
2850:
2846:
2842:
2838:
2831:
2823:
2819:
2815:
2811:
2807:
2803:
2800:(2): 219β28.
2799:
2795:
2794:
2785:
2770:
2769:
2764:
2757:
2749:
2745:
2739:
2723:
2719:
2713:
2705:
2701:
2696:
2691:
2687:
2683:
2679:
2675:
2674:
2666:
2659:
2651:
2647:
2642:
2637:
2634:(2): 155β65.
2633:
2629:
2628:
2623:
2616:
2608:
2604:
2600:
2596:
2591:
2586:
2582:
2578:
2574:
2568:
2560:
2556:
2552:
2548:
2544:
2540:
2536:
2532:
2525:
2517:
2513:
2508:
2503:
2499:
2495:
2491:
2484:
2476:
2472:
2468:
2464:
2460:
2456:
2452:
2448:
2440:
2432:
2428:
2424:
2420:
2416:
2412:
2404:
2396:
2392:
2388:
2384:
2380:
2376:
2372:
2368:
2361:
2353:
2349:
2345:
2341:
2337:
2333:
2332:
2324:
2316:
2312:
2308:
2304:
2300:
2296:
2289:
2283:
2278:
2274:
2269:
2264:
2261:(2): 423β30.
2260:
2256:
2252:
2245:
2237:
2233:
2228:
2223:
2219:
2215:
2211:
2204:
2196:
2192:
2187:
2182:
2179:(2): 173β80.
2178:
2174:
2170:
2163:
2155:
2151:
2147:
2143:
2140:(2): 111β14.
2139:
2135:
2128:
2120:
2116:
2112:
2108:
2104:
2100:
2092:
2084:
2080:
2076:
2072:
2067:
2062:
2057:
2052:
2048:
2044:
2040:
2032:
2024:
2020:
2016:
2012:
2008:
2004:
2000:
1996:
1988:
1980:
1976:
1971:
1966:
1962:
1958:
1954:
1947:
1939:
1935:
1930:
1925:
1921:
1917:
1913:
1906:
1898:
1894:
1889:
1884:
1880:
1876:
1872:
1868:
1864:
1857:
1849:
1845:
1840:
1835:
1831:
1827:
1823:
1816:
1814:
1805:
1801:
1796:
1791:
1787:
1783:
1779:
1772:
1764:
1760:
1756:
1752:
1748:
1744:
1741:(2): 263β72.
1740:
1736:
1728:
1720:
1714:
1706:
1702:
1698:
1691:
1683:
1679:
1674:
1669:
1665:
1661:
1657:
1650:
1642:
1638:
1633:
1628:
1624:
1620:
1616:
1609:
1601:
1597:
1592:
1587:
1583:
1579:
1575:
1568:
1560:
1556:
1551:
1546:
1542:
1538:
1534:
1527:
1519:
1515:
1510:
1505:
1501:
1497:
1493:
1486:
1471:
1464:
1462:
1453:
1447:
1438:
1433:
1429:
1422:
1414:
1410:
1406:
1402:
1398:
1394:
1387:
1379:
1375:
1371:
1367:
1363:
1359:
1356:(6): 546β54.
1355:
1351:
1344:
1336:
1332:
1328:
1324:
1320:
1316:
1309:
1301:
1297:
1292:
1287:
1284:(5): 664β67.
1283:
1279:
1275:
1268:
1260:
1256:
1251:
1246:
1242:
1238:
1234:
1227:
1219:
1215:
1211:
1204:
1196:
1192:
1188:
1184:
1180:
1176:
1172:
1168:
1160:
1152:
1148:
1143:
1138:
1133:
1128:
1124:
1120:
1116:
1109:
1101:
1097:
1093:
1089:
1085:
1081:
1077:
1073:
1069:
1065:
1058:
1051:
1043:
1039:
1034:
1029:
1024:
1019:
1015:
1011:
1007:
999:
991:
987:
983:
979:
975:
971:
967:
963:
956:
948:
944:
939:
934:
930:
926:
922:
915:
913:
911:
909:
907:
898:
894:
890:
886:
882:
878:
871:
867:
859:
857:
856:meta-analyses
853:
843:
839:
837:
832:
830:
826:
822:
813:
811:
807:
797:
795:
790:
780:
776:
773:
769:
765:
761:
757:
753:
750:
746:
735:
733:
722:
714:
712:
707:
704:
697:
693:
690:
687:
683:
679:
676:
673:
669:
665:
661:
660:Beta blockers
658:
657:
656:
647:
644:
639:
637:
633:
625:
621:
617:
613:
609:
605:
601:
598:
595:
592:
591:
590:
588:
587:Cardioversion
582:Cardioversion
579:
577:
572:
568:
564:
561:
557:
552:
550:
546:
545:heart failure
542:
532:
530:
526:
522:
518:
513:
511:
507:
503:
499:
495:
486:
484:
480:
469:
466:
462:
458:
454:
450:
445:
441:
439:
435:
431:
427:
422:
419:
409:
407:
401:
399:
395:
391:
386:
384:
374:
371:
369:
364:
360:
339:
336:
335:
320:
318:
314:
311:
308:
304:
303:
299:
295:
293:
289:
285:
282:
279:
275:
274:
270:
268:
265:
262:
259:
255:
254:
250:
247:
244:
237:
236:
233:
226:
224:
220:
212:
211:
203:
199:
194:
192:
188:
184:
180:
176:
172:
168:
164:
163:anticoagulant
160:
156:
152:
148:
143:
139:
129:
123:
120:
116:
115:
114:
106:
104:
100:
96:
91:
89:
88:cardioversion
85:
81:
77:
73:
69:
65:
61:
57:
56:
43:
37:
33:
30:
28:
24:
19:
16:
3900:
3896:
3886:
3853:
3849:
3842:
3817:
3813:
3807:
3782:
3778:
3772:
3745:
3741:
3731:
3719:. Retrieved
3709:
3697:. Retrieved
3690:the original
3677:
3673:
3660:
3625:
3621:
3611:
3576:
3572:
3562:
3527:
3521:
3481:
3478:Heart Rhythm
3477:
3470:
3443:
3439:
3429:
3402:
3398:
3388:
3355:
3351:
3344:
3335:
3323:
3290:
3286:
3280:
3245:
3241:
3235:
3210:
3206:
3200:
3165:
3162:N Engl J Med
3161:
3151:
3124:
3120:
3110:
3083:
3080:N Engl J Med
3079:
3041:
3037:
3030:
3005:
3001:
2994:
2961:
2957:
2950:
2925:
2921:
2915:
2882:
2878:
2871:
2844:
2840:
2830:
2797:
2791:
2784:
2772:. Retrieved
2766:
2756:
2738:
2726:. Retrieved
2712:
2695:11343/221723
2677:
2673:N Engl J Med
2671:
2658:
2631:
2625:
2615:
2580:
2576:
2567:
2534:
2530:
2524:
2497:
2494:N Engl J Med
2493:
2483:
2450:
2446:
2439:
2414:
2410:
2403:
2370:
2366:
2360:
2335:
2329:
2323:
2298:
2294:
2288:
2258:
2254:
2244:
2217:
2213:
2203:
2176:
2172:
2162:
2137:
2133:
2127:
2102:
2098:
2091:
2066:11379/546100
2046:
2042:
2031:
1998:
1994:
1987:
1960:
1956:
1946:
1919:
1915:
1905:
1870:
1866:
1856:
1832:(1): 39β48.
1829:
1825:
1785:
1781:
1771:
1738:
1734:
1727:
1690:
1663:
1659:
1649:
1622:
1618:
1608:
1581:
1577:
1567:
1540:
1536:
1526:
1499:
1495:
1485:
1473:. Retrieved
1421:
1396:
1392:
1386:
1353:
1349:
1343:
1321:(1): 36β40.
1318:
1314:
1308:
1281:
1277:
1267:
1240:
1236:
1226:
1203:
1170:
1166:
1159:
1122:
1118:
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