Atrial Fibrillation Questions & Answers

Updated: Nov 18, 2019
  • Author: Lawrence Rosenthal, MD, PhD, FACC, FHRS; Chief Editor: Jeffrey N Rottman, MD  more...
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Questions & Answers

Overview

What is atrial fibrillation (Afib) (AF) and what cardiovascular risk factors are thought to promote it?

What are the clinical presentations of atrial fibrillation (Afib) (AF)?

What is the initial history needed and which physical exams are performed for suspected atrial fibrillation (Afib) (AF)?

What ECG findings confirm atrial fibrillation (Afib) (AF)?

What is the role of transthoracic echocardiography (TTE) in the diagnosis of atrial fibrillation (Afib) (AF)?

What is the role of transesophageal echocardiography (TEE) in the diagnosis of atrial fibrillation (Afib)(AF)?

What factors influence the clinical decision for use of rhythm control or rate control for atrial fibrillation (Afib) (AF)?

What are the ACC-AHA guidelines for anticoagulation in patients with nonvalvular atrial fibrillation (Afib) (AF)?

What are risk factors for thromboembolism in patients with atrial fibrillation (Afib) (AF)?

How is anticoagulation administered in patients with atrial fibrillation (Afib) (AF)?

Which oral anticoagulants have been approved by the FDA for use in patients with atrial fibrillation (Afib) (AF)?

What factors increase the risk of bleeding with anticoagulation in patients with atrial fibrillation (Afib) (AF)?

What anticoagulation treatment alternatives exist for patients with atrial fibrillation (Afib) (AF) and high risk of clinically significant bleeding?

What are the rate control strategies for management of atrial fibrillation (Afib) (AF)?

What are the rhythm control strategies for management of atrial fibrillation (Afib) (AF)?

What are the guidelines for catheter ablation in patients with atrial fibrillation (Afib) (AF)?

What is paroxysmal atrial fibrillation (Afib) (AF)?

What are the guidelines for classification of atrial fibrillation (Afib) (AF)?

What is persistent atrial fibrillation (Afib) (AF)?

What are the main treatment goals for patients with permanent atrial fibrillation (Afib) (AF)?

What is the definition of lone atrial fibrillation (Afib) (AF)?

What are the forms of atrial remodeling during a progression of atrial fibrillation (Afib) (AF)?

What are the causes of contractile remodeling during progression of atrial fibrillation (Afib) (AF)?

What is the role of inflammatory cells in the atrial myocardium in atrial fibrillation (Afib) (AF)?

What is the relationship between comorbid cardiovascular diseases and atrial fibrillation (Afib) (AF)?

What is the role of insulin resistance in the pathogenesis of atrial fibrillation (Afib) (AF)?

What is the pathophysiology of atrial fibrillation (Afib) (AF)?

What is the automatic focus theory of atrial fibrillation (Afib) (AF)?

What is the multiple wavelet hypothesis of atrial fibrillation (Afib) (AF)?

Which risk factors are most strongly associated with atrial fibrillation (Afib) (AF)?

How does hemodynamic stress increase the risk of developing atrial fibrillation (Afib) (AF)?

How does atrial ischemia affect atrial fibrillation (Afib) (AF)?

What are inflammatory causes of atrial fibrillation (Afib) (AF)?

Which noncardiovascular respiratory disorders increase the risk for atrial fibrillation (Afib) (AF)?

How is drug and alcohol abuse related to atrial fibrillation (Afib) (AF)?

Which endocrine disorders are associated with atrial fibrillation (Afib) (AF)?

Which neurologic disorders are known to precipitate atrial fibrillation (Afib) (AF)?

What is the role of genetics in the etiology of atrial fibrillation (Afib) (AF)?

How does age affect the risk of atrial fibrillation (Afib) (AF)?

What is the role of chronic kidney disease (CKD) and/or anemia in the etiology of atrial fibrillation (Afib) (AF)?

What is the prevalence of atrial fibrillation (Afib) (AF) in the US?

What is the prevalence of atrial fibrillation (Afib) (AF) among different age groups?

How does the incidence of atrial fibrillation (Afib) (AF) differ by gender or race?

What are the common comorbidities occurring with atrial fibrillation (Afib) (AF)?

What is the risk of stroke associated with atrial fibrillation (Afib) (AF)?

What is the risk of mortality associated with atrial fibrillation (Afib) (AF)?

What are the morbidity and mortality risks associated with atrial fibrillation (Afib) (AF)?

Which blood-thinning agents are used to reduce the risk of stroke in atrial fibrillation (Afib) (AF) lasting longer than 24 hours?

Can atrial fibrillation (Afib) (AF) affect cognitive function?

How does the presence of atrial fibrillation (Afib) (AF) in the setting of acute myocardial infarction affect the patient’s prognosis?

Presentation

What is the clinical presentation and initial evaluation of atrial fibrillation (Afib) (AF)?

What are the signs and symptoms of atrial fibrillation (Afib) (AF)?

What is the focus of the history for atrial fibrillation (Afib) (AF)?

What is the initial physical exam for atrial fibrillation (Afib) (AF)?

What role do vital signs play during the initial exam of atrial fibrillation (Afib) (AF)?

Which findings of a head and neck exam for atrial fibrillation (Afib) (AF) suggest an increased likelihood of comorbid coronary artery disease?

What is the role of a pulmonary exam for atrial fibrillation (Afib) (AF)?

Which findings from a cardiac exam for atrial fibrillation (Afib) (AF) suggest valvular heart disease?

What is the role of an abdominal exam for atrial fibrillation (Afib) (AF)?

Which findings from an exam of the low extremities for atrial fibrillation (Afib) (AF) suggest peripheral arterial disease?

What is the role of neurologic exams for atrial fibrillation (Afib) (AF)?

DDX

What is the basis for a diagnosis of atrial fibrillation (Afib) (AF)?

What are the differential diagnoses for Atrial Fibrillation?

Workup

Which cardiac tests are recommended following the diagnosis of atrial fibrillation (Afib) (AF)?

When are chest radiography and thyroid function testing indicated following the diagnosis of atrial fibrillation (Afib) (AF)?

Which electrocardiography findings confirm the diagnosis of atrial fibrillation (Afib) (AF)?

Which lab studies are indicated following the diagnosis of atrial fibrillation (Afib) (AF)?

How is echocardiography used following the diagnosis of atrial fibrillation (Afib) (AF)?

Which imaging studies are used to evaluate atrial anatomy in patients with atrial fibrillation (Afib) (AF)?

What is the role of preablation delayed-enhancement magnetic resonance imaging (DE-MRI) in predicting treatment outcomes for patients with atrial fibrillation (Afib) (AF)?

What is the role of six-minute walk or exercise testing for atrial fibrillation (Afib) (AF)

What is the role of Holter monitoring and event recording for atrial fibrillation (Afib) (AF)?

What is the role of electrophysiology studies for atrial fibrillation (Afib) (AF)?

Treatment

What are the treatment choices for patients with atrial fibrillation (Afib) (AF)?

What is the role of sinus rhythm restoration in the treatment of atrial fibrillation (Afib) (AF)?

How does the rhythm control strategy affect risk of stroke associated with atrial fibrillation (Afib) (AF)?

What new treatments for atrial fibrillation (Afib) (AF) are being investigated?

What are the risk factors for stroke and how do they affect atrial fibrillation (Afib) (AF) anticoagulation management decisions?

What is the efficacy of anticoagulation with warfarin to decrease stroke risk associated with atrial fibrillation (Afib) (AF)?

When are anticoagulants indicated in low-risk patients with atrial fibrillation (Afib) (AF)?

What are the risks of concomitant antiplatelet therapy with oral anticoagulation in patients with atrial fibrillation (Afib) (AF)?

What effect does aspirin as monotherapy for atrial fibrillation (Afib) (AF) have on the risk of stroke?

Which risk factor assessment algorithms have been developed to aid in making anticoagulation decisions for patients with atrial fibrillation (Afib) (AF)?

What are the ACC/AHA guidelines on anticoagulation for patients with nonvalvular atrial fibrillation (Afib) (AF)?

What are guidelines for the initial treatment of asymptomatic patients with atrial fibrillation (Afib) (AF)?

What are the determinants of the ventricular rate during atrial fibrillation (Afib) (AF)?

What are the first-line agents for rate control in patients with atrial fibrillation (Afib) (AF)?

When is digoxin indicated for rate control in patients with atrial fibrillation (Afib) (AF)?

When is amiodarone recommended by guidelines for rate control in patients with atrial fibrillation (Afib) (AF)?

Which agents are contraindicated in patients with preexcitation syndrome and atrial fibrillation (Afib) (AF)?

What is the most important consideration for the acute management of atrial fibrillation (Afib) (AF)?

Which transesophageal echocardiography findings predict low acute risk of stroke in patients with atrial fibrillation (Afib) (AF)?

Which anticoagulation treatments can be administered to patients with atrial fibrillation (Afib) (AF) awaiting electrical cardioversion?

When and how is cardioversion performed in patients with new-onset atrial fibrillation (Afib) (AF)?

When is inpatient monitoring necessary for pharmacologic cardioversion in atrial fibrillation (Afib) (AF)?

What is the focus of the long-term management of patients with atrial fibrillation (Afib)(AF)?

What is the basis of clinical decisions for long-term management in patients with atrial fibrillation (Afib) (AF)?

What is the goal of long-term anticoagulation in atrial fibrillation (Afib) (AF) and which anticoagulants are approved?

Why and how should the international normalized ratio (INR) be adjusted for anticoagulation therapy with warfarin in patients with atrial fibrillation (Afib) (AF)?

How does efficacy of anticoagulation and antiplatelet therapies change as patients with atrial fibrillation (Afib) (AF) age?

Which factors affect bleeding risk during anticoagulation therapy with warfarin in patients with atrial fibrillation (Afib) (AF)?

What is the HEMORR2HAGES risk model and how is it scored?

What is the efficacy and safety of dabigatran (Pradaxa) use in patients with atrial fibrillation (Afib) (AF)?

What is the efficacy and safety of rivaroxaban (Xarelto) use in patients with atrial fibrillation (Afib) (AF)?

What is the efficacy and safety of apixaban (Eliquis) use in patients with atrial fibrillation (Afib) (AF)?

What is the efficacy and safety of edoxaban (Savaysa) use in patients with atrial fibrillation (Afib) (AF)?

What are the advantages and disadvantages of newer oral anticoagulants for treatment of atrial fibrillation (Afib) (AF)?

When is reversal of anticoagulation required and how is it achieved in patients with atrial fibrillation (Afib) (AF)?

What are the AAN guidelines for stroke prevention in patients with nonvalvular atrial fibrillation (Afib) (AF)?

What factors should be considered when deciding whether to stop anticoagulation prior to elective surgery in patients with atrial fibrillation (Afib) (AF)?

Do patients who develop atrial fibrillation (Afib) (AF) postoperatively need anticoagulation?

When is colchicine indicated in the treatment of atrial fibrillation (Afib) (AF)?

What is the bleeding risk of anticoagulants prescribed upon hospital discharge for atrial fibrillation (Afib) (AF)?

What is the efficacy and safety of omega-3 fatty acids as treatment for paroxysmal atrial fibrillation (Afib) (AF)?

What is the efficacy and safety of ACE inhibitors and ACE-receptor blockers (ARB) to reduce recurrence of atrial fibrillation (Afib) (AF) in patients with heart failure?

What is the efficacy and safety of an initial rate-control strategy for treatment of patients with atrial fibrillation (Afib) (AF)?

How should rate control be monitored in patients with atrial fibrillation (Afib)?

What drugs can be used to achieve rate control in patients with atrial fibrillation (Afib) (AF)?

What treatments are used to maintain sinus rhythm control in patients with atrial fibrillation (Afib) (AF)?

What is the efficacy and safety of amiodarone for sinus rhythm control in patients with atrial fibrillation (Afib) (AF)?

What is the efficacy and safety of dronedarone for sinus rhythm control in patients with atrial fibrillation (Afib) (AF)?

What is the efficacy and safety of sotalol for sinus rhythm control in patients with atrial fibrillation (Afib) (AF)?

What is the rate of proarrhythmias in patients with atrial fibrillation (Afib) (AF) taking dofetilide for cardioversion?

When are class III agents and class Ic drugs contraindicated for long-term management of atrial fibrillation (Afib) (AF)?

What are the guidelines for catheter ablation to achieve rhythm control in patients with atrial fibrillation (Afib) (AF)?

What new medical and device-based rhythm-control therapies are being evaluated for atrial fibrillation (Afib) (AF)?

When is cardioversion necessary for patients with atrial fibrillation (Afib) (AF)?

What is direct current cardioversion for atrial fibrillation (Afib) (AF)?

What are the complications of cardioversion for atrial fibrillation (Afib) (AF)?

Which is the best method of cardioversion for patients with atrial fibrillation (Afib) (AF)?

What measures increase the safety of cardioversion in patients with implanted pacemakers and defibrillator devices?

When is pharmacologic cardioversion used for atrial fibrillation (Afib) (AF)?

What is the efficacy of self-administration of pharmacologic cardioversion for atrial fibrillation (Afib) (AF)?

What pretreatment medications are effective for DC cardioversion in atrial fibrillation (Afib) (AF)?

Should antiarrhythmic drugs be used in hemodynamically unstable patients?

How can postoperative atrial fibrillation (Afib) (AF) be prevented?

What is the goal of catheter ablation and surgical treatment for atrial fibrillation (Afib) (AF)?

How does ablation treat paroxysmal atrial fibrillation (Afib) (AF)?

What is the role of antiarrhythmic drug treatment after ablation of paroxysmal atrial fibrillation (Afib) (AF)?

What is the efficacy and safety of atrial fibrillation (Afib) (AF) ablation in patients with mitral valve replacement?

How is the atria compartmentalized in patients with atrial fibrillation (Afib) (AF)?

What is the maze procedure method of surgical compartmentalization of the atria in atrial fibrillation (Afib) (AF)?

What is the role of radiofrequency (RF) lesions in the surgical compartmentalization of the atria in atrial fibrillation (Afib) (AF)?

How effective is electrical isolation of individual pulmonary veins in patients with atrial fibrillation (Afib) (AF)?

What are catheter-based modalities for isolating pulmonary venous triggers and when are they indicated in atrial fibrillation (Afib) (AF)?

What is the role of chest CT scanning or MRI in imaging pulmonary veins in atrial fibrillation (Afib) (AF)?

How does sinus node function influence the atrial fibrillation (Afib) (AF) cure rate after pulmonary vein isolation?

What is the success rate of ablation of atrial fibrillation (Afib) (AF) and who are potential candidates?

After atrial fibrillation (Afib) (AF) ablation, what is the likelihood that the patient will undergo repeat ablations?

What are the complications associated with catheter ablation of atrial fibrillation (Afib) (AF)?

When should atrioventricular (AV) node modifications be considered for atrial fibrillation (Afib) (AF) and how should pacemakers be programmed?

What is the efficacy and safety of devices for left atrial appendage (LAA) closure/litigation in atrial fibrillation (Afib) (AF)?

What consultations are recommended for atrial fibrillation (Afib) (AF)?

What long-term monitoring is required for patients who undergo atrial fibrillation (Afib) (AF) catheter ablation?

What long-term monitoring is required for patients with atrial fibrillation (Afib) (AF)?

Guidelines

How do guidelines classify atrial fibrillation (Afib) (AF)?

What are the guidelines for the prevention of stroke in patients with atrial fibrillation (Afib) (AF)?

What are the differences in guidelines recommendations for antithrombotic therapy in patients with atrial fibrillation (Afib) (AF)?

What are the guidelines for rate control in patients with atrial fibrillation (Afib) (AF)?

What are the guidelines for cardioversion of atrial fibrillation (Afib) (AF)?

What are the guidelines for maintaining sinus rhythm in patients with atrial fibrillation (Afib) (AF)?

What are the guidelines for catheter ablation for atrial fibrillation (Afib) (AF)?

Medications

What is the goals of medical therapy for atrial fibrillation (Afib) (AF)?

How safe is warfarin in patients with atrial fibrillation (Afib) (AF)?

How safe is clopidogrel and aspirin in patients with atrial fibrillation (Afib) (AF)?

What is the goal of antiarrhythmic drug therapy in atrial fibrillation (Afib) (AF) and which drugs are used?

Which medications in the drug class Calcium Channel blockers are used in the treatment of Atrial Fibrillation?

Which medications in the drug class Beta-adrenergic Receptor Blockers are used in the treatment of Atrial Fibrillation?

Which medications in the drug class Cardiac glycosides are used in the treatment of Atrial Fibrillation?

Which medications in the drug class Antiarrhythmics, class IA are used in the treatment of Atrial Fibrillation?

Which medications in the drug class Antiarrhythmics, class IC are used in the treatment of Atrial Fibrillation?

Which medications in the drug class Antiarrhythmics, class III are used in the treatment of Atrial Fibrillation?

Which medications in the drug class Antiarrhythmic Agent, Miscellaneous are used in the treatment of Atrial Fibrillation?

Which medications in the drug class Anticoagulants are used in the treatment of Atrial Fibrillation?

Which medications in the drug class Antiplatelet Agents are used in the treatment of Atrial Fibrillation?