Modern aspects of treatment for patients with atrial fibrillation (a literature review)
DOI:
https://doi.org/10.14739/2310-1210.2022.6.260847Keywords:
atrial fibrillation, treatment, risk factors, anticoagulant therapy, symptom controlAbstract
The aim of the work is to analyze and summarize the data of the scientific literature which highlight modern approaches to the management of patients with atrial fibrillation (AF).
In the article, on the basis of the modern literature analysis, the basic therapeutic directions and methods of surgical correction of AF are analyzed. Emphasis is placed on the need to treat AF patients in accordance with the ABC strategy, which includes the prevention of thromboembolic complications (A), control of symptoms (B), as well as treatment of comorbidities and elimination of risk factors (C). The main risk factors for AF, its relationship with other cardiovascular events (including mortality, stroke rate and acute coronary syndrome) are analyzed, the main scales used to objectively assess the risks of AF are determined, and detailed analysis of different strategies for anticoagulant therapy is conducted. The main approaches to the control of symptoms by regulating the frequency of ventricular rhythm, restoration and maintenance of sinus rhythm with the use of cardioversion, the administration of antiarrhythmic peptide and catheter ablation are considered. In addition, attention is paid to the need to identify and treat comorbidities, cardiometabolic risk factors and lifestyle, which complement stroke prevention and reduce the severity of AF and symptoms.
Conclusions. A large number of clinical studies is focused on AF, the main idea of which is the integrated management of AF to improve the prognosis and quality of patients’ life. According to current recommendations, treatment of a patient with AF should be consistent and in accordance with the ABC strategy. Taking into account etiological factors, cardiometabolic risk factors, lifestyle, comorbid conditions will allow physicians to timely individualize complex treatment of patients with AF.
References
Hindricks, G., Potpara, T., Dagres, N., Arbelo, E., Bax, J. J., Blomström-Lundqvist, C., Boriani, G., Castella, M., Dan, G. A., Dilaveris, P. E., Fauchier, L., Filippatos, G., Kalman, J. M., La Meir, M., Lane, D. A., Lebeau, J. P., Lettino, M., Lip, G., Pinto, F. J., Thomas, G. N., … ESC Scientific Document Group (2021). 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. European heart journal, 42(5), 373-498. https://doi.org/10.1093/eurheartj/ehaa612
Steinberg, J. S., O'Connell, H., Li, S., & Ziegler, P. D. (2018). Thirty-Second Gold Standard Definition of Atrial Fibrillation and Its Relationship With Subsequent Arrhythmia Patterns: Analysis of a Large Prospective Device Database. Circulation. Arrhythmia and electrophysiology, 11(7), e006274. https://doi.org/10.1161/CIRCEP.118.006274
Benjamin, E. J., Muntner, P., Alonso, A., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Chang, A. R., Cheng, S., Das, S. R., Delling, F. N., Djousse, L., Elkind, M., Ferguson, J. F., Fornage, M., Jordan, L. C., Khan, S. S., Kissela, B. M., Knutson, K. L., Kwan, T. W., … American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee (2019). Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation, 139(10), e56-e528. https://doi.org/10.1161/CIR.0000000000000659
Angiolillo, D. J., Bhatt, D. L., Cannon, C. P., Eikelboom, J. W., Gibson, C. M., Goodman, S. G., Granger, C. B., Holmes, D. R., Lopes, R. D., Mehran, R., Moliterno, D. J., Price, M. J., Saw, J., Tanguay, J. F., & Faxon, D. P. (2021). Antithrombotic Therapy in Patients With Atrial Fibrillation Treated With Oral Anticoagulation Undergoing Percutaneous Coronary Intervention: A North American Perspective: 2021 Update. Circulation, 143(6), 583-596. https://doi.org/10.1161/CIRCULATIONAHA.120.050438
Jawitz, O. K., Wang, T. Y., Lopes, R. D., Chavez, A., Boyer, B., Kim, H., Anstrom, K. J., Becker, R. C., Blackstone, E., Ruel, M., Thourani, V. H., Puskas, J. D., Gerdisch, M. W., Johnston, D., Capps, S., Alexander, J. H., & Svensson, L. G. (2020). Rationale and design of PROACT Xa: A randomized, multicenter, open-label, clinical trial to evaluate the efficacy and safety of apixaban versus warfarin in patients with a mechanical On-X Aortic Heart Valve. American heart journal, 227, 91-99. https://doi.org/10.1016/j.ahj.2020.06.014
Lip G. (2017). The ABC pathway: an integrated approach to improve AF management. Nature reviews. Cardiology, 14(11), 627-628. https://doi.org/10.1038/nrcardio.2017.153
Proietti, M., Romiti, G. F., Olshansky, B., Lane, D. A., & Lip, G. (2018). Improved Outcomes by Integrated Care of Anticoagulated Patients with Atrial Fibrillation Using the Simple ABC (Atrial Fibrillation Better Care) Pathway. The American journal of medicine, 131(11), 1359-1366.e6. https://doi.org/10.1016/j.amjmed.2018.06.012
Yoon, M., Yang, P. S., Jang, E., Yu, H. T., Kim, T. H., Uhm, J. S., Kim, J. Y., Sung, J. H., Pak, H. N., Lee, M. H., Joung, B., & Lip, G. (2019). Improved Population-Based Clinical Outcomes of Patients with Atrial Fibrillation by Compliance with the Simple ABC (Atrial Fibrillation Better Care) Pathway for Integrated Care Management: A Nationwide Cohort Study. Thrombosis and haemostasis, 119(10), 1695-1703. https://doi.org/10.1055/s-0039-1693516
Pastori, D., Pignatelli, P., Menichelli, D., Violi, F., & Lip, G. (2019). Integrated Care Management of Patients With Atrial Fibrillation and Risk of Cardiovascular Events: The ABC (Atrial fibrillation Better Care) Pathway in the ATHERO-AF Study Cohort. Mayo Clinic proceedings, 94(7), 1261-1267. https://doi.org/10.1016/j.mayocp.2018.10.022
Gupta, K., Trocio, J., Keshishian, A., Zhang, Q., Dina, O., Mardekian, J., Nadkarni, A., & Shank, T. C. (2019). Effectiveness and safety of direct oral anticoagulants compared to warfarin in treatment naïve non-valvular atrial fibrillation patients in the US Department of defense population. BMC cardiovascular disorders, 19(1), 142. https://doi.org/10.1186/s12872-019-1116-1
Nazha, B., Pandya, B., Cohen, J., Zhang, M., Lopes, R. D., Garcia, D. A., Sherwood, M. W., & Spyropoulos, A. C. (2018). Periprocedural Outcomes of Direct Oral Anticoagulants Versus Warfarin in Nonvalvular Atrial Fibrillation. Circulation, 138(14), 1402-1411. https://doi.org/10.1161/CIRCULATIONAHA.117.031457
Mykhaylovskyi, Ya. M. (2022). Vplyv klinichnykh i henetychnykh chynnykiv na stabilnist antykoahuliatsii varfarynom u khvorykh iz fibryliatsiieiu peredserd [The influence of clinical and genetic factors on the stability of warfarin’s anticoagulant effect in patients with atrial fibrillation] Patologia, 19(1), 12-17. [in Ukrainian]. https://doi.org/10.14739/2310-1237.2022.1.252662
Kolesnyk, M. Y., & Mykhailovskyi, Y. M. (2021). The interrelation of CYP2C9, CYP4F2, VKORC1 genes polymorphisms with warfarin dose and hemorrhagic complications risk rise in patients with atrial fibrillation: a retrospective study. East European scienetific journal, (1), 37-43.
Kolesnyk, M. Yu., Kamyshny, O. M & Mikhailovsky, Ya. M. (2018). Vzaiemozviazok polimorfizmu heniv CYP2C9, CYP4F2, VKORC1 z rozvytkom hemorahichnykh uskladnen pry terapii varfarynom u khvorykh z fibryliatsiieiu peredserd: rezultaty odnotsentrovoho richnoho sposterezhennia [The interrelation of CYP2C9, CYP4F2, VKORC1 genes polymorphism and hemorrhagic complications of warfarin therapy in patients with atrial fibrillation: a single-center one-year study]. Ukrainskyi kardiolohichnyi zhurnal, (1), 54-59. [in Ukrainian].
Freedman, B., Hindricks, G., Banerjee, A., Baranchuk, A., Ching, C. K., Du, X., Fitzsimons, D., Healey, J. S., Ikeda, T., Lobban, T., Mbakwem, A., Narasimhan, C., Neubeck, L., Noseworthy, P., Philbin, D. M., Jr, Pinto, F. J., Rwebembera, J., Schnabel, R. B., Svendsen, J. H., Aguinaga, L., … Stepinska, J. (2021). World Heart Federation Roadmap on Atrial Fibrillation - A 2020 Update. Global heart, 16(1), 41. https://doi.org/10.5334/gh.1023
Schnabel, R. B., Pecen, L., Rzayeva, N., Lucerna, M., Purmah, Y., Ojeda, F. M., De Caterina, R., & Kirchhof, P. (2018). Symptom Burden of Atrial Fibrillation and Its Relation to Interventions and Outcome in Europe. Journal of the American Heart Association, 7(11), e007559. https://doi.org/10.1161/JAHA.117.007559
Alobaida, M., & Alrumayh, A. (2021). Rate control strategies for atrial fibrillation. Annals of medicine, 53(1), 682-692. https://doi.org/10.1080/07853890.2021.1930137
Schnabel, R. B., Rillig, A., & Kirchhof, P. (2021). Vorhofflimmern [Atrial fibrillation]. Der Internist, 62(10), 1065-1073. https://doi.org/10.1007/s00108-021-01067-0
Di Monaco, A., Vitulano, N., Troisi, F., Quadrini, F., Romanazzi, I., Calvi, V., & Grimaldi, M. (2022). Pulsed Field Ablation to Treat Atrial Fibrillation: A Review of the Literature. Journal of cardiovascular development and disease, 9(4), 94. https://doi.org/10.3390/jcdd9040094
Kirchhof, P., Camm, A. J., Goette, A., Brandes, A., Eckardt, L., Elvan, A., Fetsch, T., van Gelder, I. C., Haase, D., Haegeli, L. M., Hamann, F., Heidbüchel, H., Hindricks, G., Kautzner, J., Kuck, K. H., Mont, L., Ng, G. A., Rekosz, J., Schoen, N., Schotten, U., … EAST-AFNET 4 Trial Investigators (2020). Early Rhythm-Control Therapy in Patients with Atrial Fibrillation. The New England journal of medicine, 383(14), 1305-1316. https://doi.org/10.1056/NEJMoa2019422
Lau, D. H., Linz, D., & Sanders, P. (2019). New Findings in Atrial Fibrillation Mechanisms. Cardiac electrophysiology clinics, 11(4), 563-571. https://doi.org/10.1016/j.ccep.2019.08.007
Elliott, A. D., Linz, D., Verdicchio, C. V., & Sanders, P. (2018). Exercise and Atrial Fibrillation: Prevention or Causation?. Heart, lung & circulation, 27(9), 1078-1085. https://doi.org/10.1016/j.hlc.2018.04.296
Heijman, J., Linz, D., & Schotten, U. (2021). Dynamics of Atrial Fibrillation Mechanisms and Comorbidities. Annual review of physiology, 83, 83-106. https://doi.org/10.1146/annurev-physiol-031720-085307
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