Atrial Fibrillation
P re f a c e Atrial Fibrillation
Hakan Oral, MD Editor
catheter ablation has evolved as an effective treatment option in patients with AF, particularly paroxysmal AF, and has been widely adopted. Ongoing efforts to better define and map the targets that perpetuate AF will be helpful to further improve the outcomes of catheter ablation in patients with persistent AF. In patients undergoing cardiac surgery and who also have AF, surgical ablation is usually the preferred treatment modality and has been refined over the last decade. One of the most important decisions to make in the care of patients with AF is whether to pursue a rate-control or rhythm-control strategy. Since rhythm control is extremely difficult once AF has been persistent for several years with extensive electroanatomical remodeling, choosing the right strategy will have life-long implications and has been discussed in detail. Likewise, choice of appropriate antiarrhythmic drug therapy specifically in the presence of structural heart disease is important considering the risk of proarrhythmia. Accurate assessment of the relative stroke and hemorrhagic risk is essential for every patient with AF. Appropriate use and selection of anticoagulants are critically important to prevent probably the most serious complication of AF, stroke. As nonpharmacologic means to exclude left atrial
Cardiol Clin 32 (2014) xi–xii http://dx.doi.org/10.1016/j.ccl.2014.08.001 0733-8651/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.
cardiology.theclinics.com
With over 6 million patients affected only in the United States, atrial fibrillation (AF) is a major health problem with profound effects on both the individual patient and society at large. As a matter of fact, the Institute of Medicine has identified AF as one of the priority disease states. In this issue of Cardiology Clinics, we have focused on AF and tried to cover the most important and relevant aspects in a comprehensive and contemporary review. A distinguished group of experts and leaders in basic and experimental electrophysiology, epidemiology, clinical pharmacology, interventional clinical electrophysiology, and cardiac surgery contributed state-of-the-art reviews and also shared their insight to the future of AF. It is clear that the pathogenesis of AF is multifactorial. Both genetically and environmentally acquired factors play a role in the initiation and progression of AF. Better understanding of the mechanisms of AF will be important for primary prevention of AF and also to improve the outcome of current pharmacologic and nonpharmacologic treatment modalities. Upstream therapies that block and/or modify pathways that promote AF are likely to be helpful and need to be further explored. As we better understand the mechanisms of AF, and as a result of technological advances,
xii
Preface appendage continue to evolve, and with the addition of novel oral anticoagulants, there are more options to reduce the risk of stroke than ever before. However, the fundamental question of whether AF with associated atrial contractile dysfunction is the primary cause of thromboembolism or is just a surrogate for systemic thrombophilia remains to be determined pending the results of large randomized studies. I hope you will find this issue helpful to your practice and the care of your patients. The art of medicine is tailoring therapy for the individual
patient, with the patient. That is how we all make a difference.. Hakan Oral, MD Cardiac Arrhythmia Service University of Michigan Cardiovascular Center, SPC 5853 1500 E. Medical Center Drive Ann Arbor, MI 48109-5853, USA E-mail address: [email protected]
P re f a c e Atrial Fibrillation
Hakan Oral, MD Editor
catheter ablation has evolved as an effective treatment option in patients with AF, particularly paroxysmal AF, and has been widely adopted. Ongoing efforts to better define and map the targets that perpetuate AF will be helpful to further improve the outcomes of catheter ablation in patients with persistent AF. In patients undergoing cardiac surgery and who also have AF, surgical ablation is usually the preferred treatment modality and has been refined over the last decade. One of the most important decisions to make in the care of patients with AF is whether to pursue a rate-control or rhythm-control strategy. Since rhythm control is extremely difficult once AF has been persistent for several years with extensive electroanatomical remodeling, choosing the right strategy will have life-long implications and has been discussed in detail. Likewise, choice of appropriate antiarrhythmic drug therapy specifically in the presence of structural heart disease is important considering the risk of proarrhythmia. Accurate assessment of the relative stroke and hemorrhagic risk is essential for every patient with AF. Appropriate use and selection of anticoagulants are critically important to prevent probably the most serious complication of AF, stroke. As nonpharmacologic means to exclude left atrial
Cardiol Clin 32 (2014) xi–xii http://dx.doi.org/10.1016/j.ccl.2014.08.001 0733-8651/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.
cardiology.theclinics.com
With over 6 million patients affected only in the United States, atrial fibrillation (AF) is a major health problem with profound effects on both the individual patient and society at large. As a matter of fact, the Institute of Medicine has identified AF as one of the priority disease states. In this issue of Cardiology Clinics, we have focused on AF and tried to cover the most important and relevant aspects in a comprehensive and contemporary review. A distinguished group of experts and leaders in basic and experimental electrophysiology, epidemiology, clinical pharmacology, interventional clinical electrophysiology, and cardiac surgery contributed state-of-the-art reviews and also shared their insight to the future of AF. It is clear that the pathogenesis of AF is multifactorial. Both genetically and environmentally acquired factors play a role in the initiation and progression of AF. Better understanding of the mechanisms of AF will be important for primary prevention of AF and also to improve the outcome of current pharmacologic and nonpharmacologic treatment modalities. Upstream therapies that block and/or modify pathways that promote AF are likely to be helpful and need to be further explored. As we better understand the mechanisms of AF, and as a result of technological advances,
xii
Preface appendage continue to evolve, and with the addition of novel oral anticoagulants, there are more options to reduce the risk of stroke than ever before. However, the fundamental question of whether AF with associated atrial contractile dysfunction is the primary cause of thromboembolism or is just a surrogate for systemic thrombophilia remains to be determined pending the results of large randomized studies. I hope you will find this issue helpful to your practice and the care of your patients. The art of medicine is tailoring therapy for the individual
patient, with the patient. That is how we all make a difference.. Hakan Oral, MD Cardiac Arrhythmia Service University of Michigan Cardiovascular Center, SPC 5853 1500 E. Medical Center Drive Ann Arbor, MI 48109-5853, USA E-mail address: [email protected]
