Atrial fibrillation natural history, complications and prognosis: Difference between revisions

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==Overview==
==Overview==
Atrial fibrillation can be complicated by embolic events including [[stroke]] and [[systemic embolization]]. The [[atrial kick]] (active filling of the [[left ventricle]] by atrial contraction) often contributes importantly to the filling of the [[left ventricle]], and the loss of the [[atrial kick]] can be associated with the development of [[congestive heart failure]].
The natural tendency of [[atrial fibrillation]] is to become a [[Chronic (medical)|chronic]] condition. Based on [[Epidemiology|epidemiological studies]] [[atrial fibrillation]] starts as the paroxysmal form and then evolves to the permanent form eventually in some cases. Numerous [[Complication (medicine)|complications]] in association to [[atrial fibrillation]] (such as impaired [[cardiac output]], [[stroke]], [[heart failure]] and [[Cognition|Cognitive disturbances]]) have been recognized. Although after introduction of [[anticoagulant]] [[treatment]] rate of [[stroke]] and consequently risk of death have been decreased. In a study done on Swedish [[patients]] with [[atrial fibrillation]] risk of [[stroke]] is 25 per 1,000 person/year in [[patients]] treated with [[anticoagulants]], compared to 45 per 1,000 person/year risk of [[stroke]] in [[AF]] [[patients]] who didn't received [[anticoagulant]] [[therapy]]. The occurrence of [[atrial fibrillation]] in the setting of [[ST elevation MI]] is associated with a poor [[prognosis]] including a 40% rise in the risk of [[mortality rate|mortality]] in meta-analyses.  
 
==Natural History==
==Natural History==
*[[Atrial fibrillation]] may be continuous (persistent or permanent [[Atrial fibrillation|AF]]) or alternating between periods of a normal [[Sinus rhythm|heart rhythm]] (paroxysmal [[Atrial fibrillation|AF]]).<ref name="pmid9737513">{{cite journal| author=Benjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Levy D| title=Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. | journal=Circulation | year= 1998 | volume= 98 | issue= 10 | pages= 946-52 | pmid=9737513 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9737513  }} </ref>
*[[Atrial fibrillation]] may become continuous (persistent or permanent [[Atrial fibrillation|AF]]) or alternating between periods of a normal [[Sinus rhythm|heart rhythm]] (paroxysmal [[Atrial fibrillation|AF]]). Paroxysmal [[atrial fibrillation]] formed during an extreme [[vagotonia]] is the only known exception.<ref name="pmid11156892">{{cite journal| author=Allessie MA, Boyden PA, Camm AJ, Kléber AG, Lab MJ, Legato MJ | display-authors=etal| title=Pathophysiology and prevention of atrial fibrillation. | journal=Circulation | year= 2001 | volume= 103 | issue= 5 | pages= 769-77 | pmid=11156892 | doi=10.1161/01.cir.103.5.769 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11156892  }} </ref><ref name="pmid9737513">{{cite journal| author=Benjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Levy D| title=Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. | journal=Circulation | year= 1998 | volume= 98 | issue= 10 | pages= 946-52 | pmid=9737513 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9737513  }} </ref>
*The natural tendency of [[atrial fibrillation]] is to become a [[Chronic (medical)|chronic]] condition. [[Chronic (medical)|Chronic]] [[AF]] leads to a small increase in the risk of death.<ref name="pmid9737513">{{cite journal| author=Benjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Levy D| title=Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. | journal=Circulation | year= 1998 | volume= 98 | issue= 10 | pages= 946-52 | pmid=9737513 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9737513  }} </ref><ref>{{cite journal |author=Wattigney WA, Mensah GA, Croft JB |title=Increased atrial fibrillation mortality: United States, 1980-1998 |journal=Am. J. Epidemiol. |volume=155 |issue=9 |pages=819–26 |year=2002 |pmid=11978585 |doi=10.1093/aje/155.9.819}}</ref>
*The natural tendency of [[atrial fibrillation]] is to become a [[Chronic (medical)|chronic]] condition. [[Chronic (medical)|Chronic]] [[atrial fibrillation]] leads to a small increase in the risk of death.<ref name="pmid9737513">{{cite journal| author=Benjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Levy D| title=Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. | journal=Circulation | year= 1998 | volume= 98 | issue= 10 | pages= 946-52 | pmid=9737513 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9737513  }} </ref><ref>{{cite journal |author=Wattigney WA, Mensah GA, Croft JB |title=Increased atrial fibrillation mortality: United States, 1980-1998 |journal=Am. J. Epidemiol. |volume=155 |issue=9 |pages=819–26 |year=2002 |pmid=11978585 |doi=10.1093/aje/155.9.819}}</ref>
*Based on [[Epidemiology|epidemiological studies]] [[atrial fibrillation]] starts as the paroxysmal form and then evolves to the permanent form eventually in some cases.<ref name="pmid18397874">{{cite journal| author=Nieuwlaat R, Prins MH, Le Heuzey JY, Vardas PE, Aliot E, Santini M | display-authors=etal| title=Prognosis, disease progression, and treatment of atrial fibrillation patients during 1 year: follow-up of the Euro Heart Survey on atrial fibrillation. | journal=Eur Heart J | year= 2008 | volume= 29 | issue= 9 | pages= 1181-9 | pmid=18397874 | doi=10.1093/eurheartj/ehn139 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18397874  }} </ref><ref name="pmid20170808">{{cite journal| author=de Vos CB, Pisters R, Nieuwlaat R, Prins MH, Tieleman RG, Coelen RJ | display-authors=etal| title=Progression from paroxysmal to persistent atrial fibrillation clinical correlates and prognosis. | journal=J Am Coll Cardiol | year= 2010 | volume= 55 | issue= 8 | pages= 725-31 | pmid=20170808 | doi=10.1016/j.jacc.2009.11.040 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20170808  }} </ref>
*Based on [[Epidemiology|epidemiological studies]] [[atrial fibrillation]] starts as the paroxysmal form and then evolves to the permanent form eventually in some cases.<ref name="pmid11156892">{{cite journal| author=Allessie MA, Boyden PA, Camm AJ, Kléber AG, Lab MJ, Legato MJ | display-authors=etal| title=Pathophysiology and prevention of atrial fibrillation. | journal=Circulation | year= 2001 | volume= 103 | issue= 5 | pages= 769-77 | pmid=11156892 | doi=10.1161/01.cir.103.5.769 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11156892  }} </ref><ref name="pmid18397874">{{cite journal| author=Nieuwlaat R, Prins MH, Le Heuzey JY, Vardas PE, Aliot E, Santini M | display-authors=etal| title=Prognosis, disease progression, and treatment of atrial fibrillation patients during 1 year: follow-up of the Euro Heart Survey on atrial fibrillation. | journal=Eur Heart J | year= 2008 | volume= 29 | issue= 9 | pages= 1181-9 | pmid=18397874 | doi=10.1093/eurheartj/ehn139 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18397874  }} </ref><ref name="pmid20170808">{{cite journal| author=de Vos CB, Pisters R, Nieuwlaat R, Prins MH, Tieleman RG, Coelen RJ | display-authors=etal| title=Progression from paroxysmal to persistent atrial fibrillation clinical correlates and prognosis. | journal=J Am Coll Cardiol | year= 2010 | volume= 55 | issue= 8 | pages= 725-31 | pmid=20170808 | doi=10.1016/j.jacc.2009.11.040 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20170808 }} </ref>
*Based on some studies [[atrial fibrillations]] responsive to various [[treatments]] often progress to a resistant form which can not be switched to [[sinus rhythm]].<ref name="pmid11156892">{{cite journal| author=Allessie MA, Boyden PA, Camm AJ, Kléber AG, Lab MJ, Legato MJ | display-authors=etal| title=Pathophysiology and prevention of atrial fibrillation. | journal=Circulation | year= 2001 | volume= 103 | issue= 5 | pages= 769-77 | pmid=11156892 | doi=10.1161/01.cir.103.5.769 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11156892 }} </ref>


==Complications==
==Complications==
The following are [[Complication (medicine)|complications]] of [[atrial fibrillation]]:<ref name="pmid11601835">{{cite journal |author=Fuster V, Rydén LE, Asinger RW, ''et al'' |title=ACC/AHA/ESC 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 and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology |journal=Eur. Heart J. |volume=22 |issue=20 |pages=1852–923 |year=2001 |month=October |pmid=11601835 |doi=10.1053/euhj.2001.2983 |url=}}</ref><ref name="pmid17548732">{{cite journal |author=Jahangir A, Lee V, Friedman PA, Trusty JM, Hodge DO, Kopecky SL, Packer DL, Hammill SC, Shen WK, Gersh BJ |title=Long-term progression and outcomes with aging in patients with lone atrial fibrillation: a 30-year follow-up study |journal=Circulation |volume=115 |issue=24 |pages=3050–6 |year=2007 |pmid=17548732 |doi=10.1161/CIRCULATIONAHA.106.644484}}</ref><ref name=Wolf1978>{{cite journal |author=Wolf PA, Dawber TR, Thomas HE, Kannel WB |title=Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study |journal=Neurology |volume=28 |issue=10 |pages=973–7 |year=1978 |pmid=570666 |doi=}}</ref><ref name="pmid9737513">{{cite journal| author=Benjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Levy D| title=Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. | journal=Circulation | year= 1998 | volume= 98 | issue= 10 | pages= 946-52 | pmid=9737513 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9737513  }} </ref><ref>{{cite journal |author=Wattigney WA, Mensah GA, Croft JB |title=Increased atrial fibrillation mortality: United States, 1980-1998 |journal=Am. J. Epidemiol. |volume=155 |issue=9 |pages=819–26 |year=2002 |pmid=11978585 |doi=10.1093/aje/155.9.819}}</ref><ref name="pmid18397874">{{cite journal| author=Nieuwlaat R, Prins MH, Le Heuzey JY, Vardas PE, Aliot E, Santini M | display-authors=etal| title=Prognosis, disease progression, and treatment of atrial fibrillation patients during 1 year: follow-up of the Euro Heart Survey on atrial fibrillation. | journal=Eur Heart J | year= 2008 | volume= 29 | issue= 9 | pages= 1181-9 | pmid=18397874 | doi=10.1093/eurheartj/ehn139 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18397874  }} </ref><ref name="pmid19433768">{{cite journal| author=Anter E, Jessup M, Callans DJ| title=Atrial fibrillation and heart failure: treatment considerations for a dual epidemic. | journal=Circulation | year= 2009 | volume= 119 | issue= 18 | pages= 2516-25 | pmid=19433768 | doi=10.1161/CIRCULATIONAHA.108.821306 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19433768  }} </ref><ref name="pmid17577005">{{cite journal| author=Hart RG, Pearce LA, Aguilar MI| title=Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. | journal=Ann Intern Med | year= 2007 | volume= 146 | issue= 12 | pages= 857-67 | pmid=17577005 | doi=10.7326/0003-4819-146-12-200706190-00007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17577005  }} </ref><ref name="pmid11401607">{{cite journal| author=Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ| title=Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. | journal=JAMA | year= 2001 | volume= 285 | issue= 22 | pages= 2864-70 | pmid=11401607 | doi=10.1001/jama.285.22.2864 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11401607  }} </ref>
The following are [[Complication (medicine)|complications]] of [[atrial fibrillation]]:<ref name="pmid11601835">{{cite journal |author=Fuster V, Rydén LE, Asinger RW, ''et al'' |title=ACC/AHA/ESC 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 and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology |journal=Eur. Heart J. |volume=22 |issue=20 |pages=1852–923 |year=2001 |month=October |pmid=11601835 |doi=10.1053/euhj.2001.2983 |url=}}</ref><ref name="pmid17548732">{{cite journal |author=Jahangir A, Lee V, Friedman PA, Trusty JM, Hodge DO, Kopecky SL, Packer DL, Hammill SC, Shen WK, Gersh BJ |title=Long-term progression and outcomes with aging in patients with lone atrial fibrillation: a 30-year follow-up study |journal=Circulation |volume=115 |issue=24 |pages=3050–6 |year=2007 |pmid=17548732 |doi=10.1161/CIRCULATIONAHA.106.644484}}</ref><ref name=Wolf1978>{{cite journal |author=Wolf PA, Dawber TR, Thomas HE, Kannel WB |title=Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study |journal=Neurology |volume=28 |issue=10 |pages=973–7 |year=1978 |pmid=570666 |doi=}}</ref><ref name="pmid9737513">{{cite journal| author=Benjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Levy D| title=Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. | journal=Circulation | year= 1998 | volume= 98 | issue= 10 | pages= 946-52 | pmid=9737513 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9737513  }} </ref><ref>{{cite journal |author=Wattigney WA, Mensah GA, Croft JB |title=Increased atrial fibrillation mortality: United States, 1980-1998 |journal=Am. J. Epidemiol. |volume=155 |issue=9 |pages=819–26 |year=2002 |pmid=11978585 |doi=10.1093/aje/155.9.819}}</ref><ref name="pmid18397874">{{cite journal| author=Nieuwlaat R, Prins MH, Le Heuzey JY, Vardas PE, Aliot E, Santini M | display-authors=etal| title=Prognosis, disease progression, and treatment of atrial fibrillation patients during 1 year: follow-up of the Euro Heart Survey on atrial fibrillation. | journal=Eur Heart J | year= 2008 | volume= 29 | issue= 9 | pages= 1181-9 | pmid=18397874 | doi=10.1093/eurheartj/ehn139 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18397874  }} </ref><ref name="pmid19433768">{{cite journal| author=Anter E, Jessup M, Callans DJ| title=Atrial fibrillation and heart failure: treatment considerations for a dual epidemic. | journal=Circulation | year= 2009 | volume= 119 | issue= 18 | pages= 2516-25 | pmid=19433768 | doi=10.1161/CIRCULATIONAHA.108.821306 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19433768  }} </ref><ref name="pmid17577005">{{cite journal| author=Hart RG, Pearce LA, Aguilar MI| title=Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. | journal=Ann Intern Med | year= 2007 | volume= 146 | issue= 12 | pages= 857-67 | pmid=17577005 | doi=10.7326/0003-4819-146-12-200706190-00007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17577005  }} </ref><ref name="pmid11401607">{{cite journal| author=Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ| title=Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. | journal=JAMA | year= 2001 | volume= 285 | issue= 22 | pages= 2864-70 | pmid=11401607 | doi=10.1001/jama.285.22.2864 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11401607 }} </ref><ref name="pmid22361078">{{cite journal| author=Mountantonakis SE, Grau-Sepulveda MV, Bhatt DL, Hernandez AF, Peterson ED, Fonarow GC| title=Presence of atrial fibrillation is independently associated with adverse outcomes in patients hospitalized with heart failure: an analysis of get with the guidelines-heart failure. | journal=Circ Heart Fail | year= 2012 | volume= 5 | issue= 2 | pages= 191-201 | pmid=22361078 | doi=10.1161/CIRCHEARTFAILURE.111.965681 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22361078 }} </ref>
*Reduced mechanical pumping action of the [[atrium]]:
*Reduced mechanical pumping action of the [[atrium]]:
**Due to the lack of coordination of [[atrium|atrial]] activation, there is a decline in the mechanical pumping action of the [[atrium]]. The decline in mechanical function of the [[atrium]] may or may not lead to inadequate filling of the [[ventricle|ventricles]] depending upon the importance of the [[atrium|atrial]] kick or [[atrium|atrial contribution]] to [[ventricle|ventricular]] filling in a given [[patient]].   
**Due to the lack of coordination of [[atrium|atrial]] activation, there is a decline in the mechanical pumping action of the [[atrium]]. The decline in mechanical function of the [[atrium]] may or may not lead to inadequate filling of the [[ventricle|ventricles]] depending upon the importance of the [[atrium|atrial]] kick or [[atrium|atrial contribution]] to [[ventricle|ventricular]] filling in a given [[patient]].   
**In [[patients]] with a stiff [[ventricle|left ventricle]] (such as [[patients]] with [[hypertension]]), the [[atrium|atrial]] kick may be critical to achieve adequate [[ventricle|ventricular]] filling.   
**In [[patients]] with a stiff [[ventricle|left ventricle]] (such as [[patients]] with [[hypertension]]), the [[atrium|atrial]] kick may be critical to achieve adequate [[ventricle|ventricular]] filling.   
*[[Heart failure]]:
*[[Heart failure]]:
**Risk of [[heart failure]] increases in [[patients]] with [[atrial fibrillation]], compared to normal population. Based on a study [[female|women]] with [[AF]] have 11-fold increase in risk of [[heart failure]], compared to women without [[atrial fibrillation]]. In contrast risk of [[heart failure]] in [[male]] [[patients]] with [[atrial fibrillation]] increases 3-fold, compared to men without [[AF]].
**Risk of [[heart failure]] increases in [[patients]] with [[atrial fibrillation]], compared to normal population. Based on a study [[female|women]] with [[AF]] have 11-fold increase in risk of [[heart failure]], compared to women without [[atrial fibrillation]]. In contrast risk of [[heart failure]] in [[male]] [[patients]] with [[atrial fibrillation]] increases 3-fold, compared to men without [[AF]].<ref name="pmid12473553">{{cite journal| author=Lloyd-Jones DM, Larson MG, Leip EP, Beiser A, D'Agostino RB, Kannel WB | display-authors=etal| title=Lifetime risk for developing congestive heart failure: the Framingham Heart Study. | journal=Circulation | year= 2002 | volume= 106 | issue= 24 | pages= 3068-72 | pmid=12473553 | doi=10.1161/01.cir.0000039105.49749.6f | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12473553  }} </ref><ref name="pmid22949543">{{cite journal| author=McManus DD, Rienstra M, Benjamin EJ| title=An update on the prognosis of patients with atrial fibrillation. | journal=Circulation | year= 2012 | volume= 126 | issue= 10 | pages= e143-6 | pmid=22949543 | doi=10.1161/CIRCULATIONAHA.112.129759 | pmc=3678907 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22949543  }} </ref>
**Worsening the [[Medical sign|signs]] and [[symptoms]] of [[congestive heart failure]] usually occurs in [[patients]] with previous history of [[congestive heart failure]] (particularly among [[patients]] with [[valvular heart disease]]).
**Worsening the [[Medical sign|signs]] and [[symptoms]] of [[congestive heart failure]] usually occurs in [[patients]] with previous history of [[congestive heart failure]] (particularly among [[patients]] with [[valvular heart disease]]).
**Due to the reduced [[atrium|atrial kick]] needed to fill the [[ventricle|left ventricle]].  
**Due to the reduced [[atrium|atrial kick]] needed to fill the [[ventricle|left ventricle]].  
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*Based on numerous studies the improved [[prognosis]] of [[atrial fibrillation]] has been demonstrated after [[anticoagulant]] [[treatment]].  
*Based on numerous studies the improved [[prognosis]] of [[atrial fibrillation]] has been demonstrated after [[anticoagulant]] [[treatment]].  
*In a study done on Swedish [[patients]] with [[atrial fibrillation]] risk of [[stroke]] is 25 per 1,000 person/year in [[patients]] treated with [[anticoagulants]], compared to 45 per 1,000 person/year risk of [[stroke]] in [[AF]] [[patients]] who didn't received [[anticoagulant]] [[therapy]].<ref name="pmid24966695">{{cite journal| author=Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S| title=Epidemiology of atrial fibrillation: European perspective. | journal=Clin Epidemiol | year= 2014 | volume= 6 | issue=  | pages= 213-20 | pmid=24966695 | doi=10.2147/CLEP.S47385 | pmc=4064952 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24966695  }} </ref>
*In a study done on Swedish [[patients]] with [[atrial fibrillation]] risk of [[stroke]] is 25 per 1,000 person/year in [[patients]] treated with [[anticoagulants]], compared to 45 per 1,000 person/year risk of [[stroke]] in [[AF]] [[patients]] who didn't received [[anticoagulant]] [[therapy]].<ref name="pmid24966695">{{cite journal| author=Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S| title=Epidemiology of atrial fibrillation: European perspective. | journal=Clin Epidemiol | year= 2014 | volume= 6 | issue=  | pages= 213-20 | pmid=24966695 | doi=10.2147/CLEP.S47385 | pmc=4064952 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24966695  }} </ref>
*[[Stroke]] itself increases the chance of serious disabilities and death in [[patient]] with [[atrial fibrillation]], compared to [[stroke]] in [[pateints]] without [[atrial fibrillation]].<ref name="pmid22949543">{{cite journal| author=McManus DD, Rienstra M, Benjamin EJ| title=An update on the prognosis of patients with atrial fibrillation. | journal=Circulation | year= 2012 | volume= 126 | issue= 10 | pages= e143-6 | pmid=22949543 | doi=10.1161/CIRCULATIONAHA.112.129759 | pmc=3678907 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22949543  }} </ref>
*[[Stroke]] itself increases the chance of serious disabilities and death in [[patient]] with [[atrial fibrillation]], compared to [[stroke]] in [[patients]] without [[atrial fibrillation]].<ref name="pmid22949543">{{cite journal| author=McManus DD, Rienstra M, Benjamin EJ| title=An update on the prognosis of patients with atrial fibrillation. | journal=Circulation | year= 2012 | volume= 126 | issue= 10 | pages= e143-6 | pmid=22949543 | doi=10.1161/CIRCULATIONAHA.112.129759 | pmc=3678907 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22949543  }} </ref>
*The rate of [[ischemic stroke]] among nonrheumatic [[atrial fibrillation]] [[patients]] averages over 5% per year, a rate that is between 2 and 7 times that of non-[[AF]] [[patients]].
*The rate of [[ischemic stroke]] among nonrheumatic [[atrial fibrillation]] [[patients]] averages over 5% per year, a rate that is between 2 and 7 times that of non-[[AF]] [[patients]].
** The [[CHADS Score]] can estimate this rate with greater certainty:
** The [[CHADS Score]] can estimate this rate with greater certainty:
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*The rate of [[brain]] [[ischemia]] in conjunction with [[atrial fibrillation|nonvalvular atrial fibrillation]] exceeds 7% per year.
*The rate of [[brain]] [[ischemia]] in conjunction with [[atrial fibrillation|nonvalvular atrial fibrillation]] exceeds 7% per year.
*[[Patients]] with both [[rheumatic heart disease]] and [[atrial fibrillation]] have an 17-fold risk increase when compared to age-matched controls and an attributable risk of 5 times greater than those with [[atrial fibrillation|nonrheumatic atrial fibrillation]].
*[[Patients]] with both [[rheumatic heart disease]] and [[atrial fibrillation]] have an 17-fold risk increase when compared to age-matched controls and an attributable risk of 5 times greater than those with [[atrial fibrillation|nonrheumatic atrial fibrillation]].
*[[Mortality rate]] is higher (69%) in [[patients]] with [[atrial fibrillation]] within 30 days after [[cardiac|non cardiac]] [[surgery]], compared to non [[atrial fibrillation]] [[patients]].<ref name="pmid22949543">{{cite journal| author=McManus DD, Rienstra M, Benjamin EJ| title=An update on the prognosis of patients with atrial fibrillation. | journal=Circulation | year= 2012 | volume= 126 | issue= 10 | pages= e143-6 | pmid=22949543 | doi=10.1161/CIRCULATIONAHA.112.129759 | pmc=3678907 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22949543  }} </ref><ref name="pmid21709059">{{cite journal| author=van Diepen S, Bakal JA, McAlister FA, Ezekowitz JA| title=Mortality and readmission of patients with heart failure, atrial fibrillation, or coronary artery disease undergoing noncardiac surgery: an analysis of 38 047 patients. | journal=Circulation | year= 2011 | volume= 124 | issue= 3 | pages= 289-96 | pmid=21709059 | doi=10.1161/CIRCULATIONAHA.110.011130 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21709059  }} </ref>
===Atrial Fibrillation in the Setting of STEMI===
===Atrial Fibrillation in the Setting of STEMI===
*The occurrence of [[atrial fibrillation]] in the setting of [[ST elevation MI]] is associated with a poor [[prognosis]] including a 40% rise in the risk of [[mortality rate|mortality]] in meta-analyses. <ref>Jabre P, Roger VL, Murad MH, et al. Mortality associated with atrial fibrillation in patients with myocardial infarction: a systematic review and meta-analysis. Circulation. Apr 19 2011;123(15):1587-93.</ref>   
*The occurrence of [[atrial fibrillation]] in the setting of [[ST elevation MI]] is associated with a poor [[prognosis]] including a 40% rise in the risk of [[mortality rate|mortality]] in meta-analyses. <ref>Jabre P, Roger VL, Murad MH, et al. Mortality associated with atrial fibrillation in patients with myocardial infarction: a systematic review and meta-analysis. Circulation. Apr 19 2011;123(15):1587-93.</ref>  
*Based on another study presence of [[atrial fibrillation]] increases the [[mortality rate]] in [[ST elevation myocardial infarction|MI]] [[patients]] by 4-fold.<ref name="pmid21536994">{{cite journal| author=Jabre P, Jouven X, Adnet F, Thabut G, Bielinski SJ, Weston SA | display-authors=etal| title=Atrial fibrillation and death after myocardial infarction: a community study. | journal=Circulation | year= 2011 | volume= 123 | issue= 19 | pages= 2094-100 | pmid=21536994 | doi=10.1161/CIRCULATIONAHA.110.990192 | pmc=3142914 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21536994 }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=21930850 Review in: Ann Intern Med. 2011 Sep 20;155(6):JC3-13] </ref>
*Highest rate of death in [[atrial fibrillation]] in the setting of [[ST elevation MI]] occurs when [[AF]] develop after 1 month of [[ST elevation myocardial infarction|MI]] ([[Hazard ratio|HR]], 2.58; 95% [[Confidence interval|CI]], 2.21 to 3.00). On the contrary, lowest rate of death associated to [[AF]] development after [[ST elevation myocardial infarction|MI]] occurs when [[atrial fibrillation]] develop within first 2 days of [[ST elevation myocardial infarction|MI]] ([[Hazard ratio|HR]], 1.63; 95% [[Confidence interval|CI]], 1.37 to 1.93).<ref name="pmid22949543">{{cite journal| author=McManus DD, Rienstra M, Benjamin EJ| title=An update on the prognosis of patients with atrial fibrillation. | journal=Circulation | year= 2012 | volume= 126 | issue= 10 | pages= e143-6 | pmid=22949543 | doi=10.1161/CIRCULATIONAHA.112.129759 | pmc=3678907 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22949543  }} </ref>
*The basis for this increase risk of [[mortality rate|mortality]] is not clear. Most likely it reflects the fact that [[atrial fibrillation]] is a marker of impaired [[ventricle|LV function]], but it may also reflect the loss of the [[atrium|atrial kick]] or the hazard associated with triple [[therapy]] with [[aspirin]], [[clopidogrel]], and [[coumadin]].
*The basis for this increase risk of [[mortality rate|mortality]] is not clear. Most likely it reflects the fact that [[atrial fibrillation]] is a marker of impaired [[ventricle|LV function]], but it may also reflect the loss of the [[atrium|atrial kick]] or the hazard associated with triple [[therapy]] with [[aspirin]], [[clopidogrel]], and [[coumadin]].
===Post Operative Atrial Fibrillation===
*Development of [[atrial fibrillation]] after a [[cardiology|cardiac]] [[surgery]] is a well known [[Cardiac arrhythmia|arrhythmic]] [[Complication (medicine)|complication]].<ref name="pmid22949543">{{cite journal| author=McManus DD, Rienstra M, Benjamin EJ| title=An update on the prognosis of patients with atrial fibrillation. | journal=Circulation | year= 2012 | volume= 126 | issue= 10 | pages= e143-6 | pmid=22949543 | doi=10.1161/CIRCULATIONAHA.112.129759 | pmc=3678907 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22949543  }} </ref><ref name="pmid12970234">{{cite journal| author=Elahi M, Hadjinikolaou L, Galiñanes M| title=Incidence and clinical consequences of atrial fibrillation within 1 year of first-time isolated coronary bypass surgery. | journal=Circulation | year= 2003 | volume= 108 Suppl 1 | issue=  | pages= II207-12 | pmid=12970234 | doi=10.1161/01.cir.0000089188.45285.fd | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12970234  }} </ref>
*Chance of [[surgery|post operative]] [[atrial fibrillation]] after [[Coronary artery bypass surgery|CABG]] is higher in [[patients]] younger than 70 years old.
*Previous studies on [[surgery|post operative]] [[atrial fibrillation]] demonstrated a minimal long term [[prognosis|prognostic value]].
*In contrast to previous studies, a new study with longer follow up period (6 years) reported relation between [[surgery|post operative]] [[atrial fibrillation]] and higher all causes [[mortality rate]].
*[[Atrial fibrillation]] after [[Coronary artery bypass surgery|CABG]] is also associated to [[surgery|postoperative]] [[infection]] and [[renal insufficiency]].
===Observational Studies===
===Observational Studies===
* The [[Framingham Heart Study]] also found that the annual risk of [[stroke]] attributable to [[atrial fibrillation]] increased from 1.5% in those aged 50-59 years to 23.5% for those aged 80-89 years
*The [[Framingham Heart Study]] demonstrated a high rate of death in [[patients]] with both [[atrial fibrillation]] and [[heart failure]] compared to each condition alone.<ref name="pmid22949543">{{cite journal| author=McManus DD, Rienstra M, Benjamin EJ| title=An update on the prognosis of patients with atrial fibrillation. | journal=Circulation | year= 2012 | volume= 126 | issue= 10 | pages= e143-6 | pmid=22949543 | doi=10.1161/CIRCULATIONAHA.112.129759 | pmc=3678907 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22949543  }} </ref>
* The [[Framingham Heart Study]] also found that the annual risk of [[stroke]] attributable to [[atrial fibrillation]] increased from 1.5% in those aged 50-59 years to 23.5% for those aged 80-89 years.
* In the Manitoba follow up study, [[atrial fibrillation]] doubled the risk of [[stroke]] independently of other [[risk factors]].
* In the Manitoba follow up study, [[atrial fibrillation]] doubled the risk of [[stroke]] independently of other [[risk factors]].
* The [[relative risk]] for [[stroke]] in the Whitehall study was 6.99%.
* The [[relative risk]] for [[stroke]] in the Whitehall study was 6.99%.

Latest revision as of 20:02, 31 August 2021
Resident
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]

Overview

The natural tendency of atrial fibrillation is to become a chronic condition. Based on epidemiological studies atrial fibrillation starts as the paroxysmal form and then evolves to the permanent form eventually in some cases. Numerous complications in association to atrial fibrillation (such as impaired cardiac output, stroke, heart failure and Cognitive disturbances) have been recognized. Although after introduction of anticoagulant treatment rate of stroke and consequently risk of death have been decreased. In a study done on Swedish patients with atrial fibrillation risk of stroke is 25 per 1,000 person/year in patients treated with anticoagulants, compared to 45 per 1,000 person/year risk of stroke in AF patients who didn't received anticoagulant therapy. The occurrence of atrial fibrillation in the setting of ST elevation MI is associated with a poor prognosis including a 40% rise in the risk of mortality in meta-analyses.

Natural History

Complications

The following are complications of atrial fibrillation:[6][7][8][2][9][4][10][11][12][13]


Region Year Risk of Stroke
The United States 1992 48 per 1,000 person
The United States 2007 17 per 1,000 person
Sweden 2012 25 per 1,000 person
France 2013 10 per 1,000 person


Prognosis

Atrial Fibrillation in the Setting of STEMI

Post Operative Atrial Fibrillation

Observational Studies

References

  1. ↑ 1.0 1.1 1.2 Allessie MA, Boyden PA, Camm AJ, Kléber AG, Lab MJ, Legato MJ; et al. (2001). "Pathophysiology and prevention of atrial fibrillation". Circulation. 103 (5): 769–77. doi:10.1161/01.cir.103.5.769. PMID 11156892.
  2. ↑ 2.0 2.1 2.2 Benjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Levy D (1998). "Impact of atrial fibrillation on the risk of death: the Framingham Heart Study". Circulation. 98 (10): 946–52. PMID 9737513.
  3. ↑ Wattigney WA, Mensah GA, Croft JB (2002). "Increased atrial fibrillation mortality: United States, 1980-1998". Am. J. Epidemiol. 155 (9): 819–26. doi:10.1093/aje/155.9.819. PMID 11978585.
  4. ↑ 4.0 4.1 Nieuwlaat R, Prins MH, Le Heuzey JY, Vardas PE, Aliot E, Santini M; et al. (2008). "Prognosis, disease progression, and treatment of atrial fibrillation patients during 1 year: follow-up of the Euro Heart Survey on atrial fibrillation". Eur Heart J. 29 (9): 1181–9. doi:10.1093/eurheartj/ehn139. PMID 18397874.
  5. ↑ de Vos CB, Pisters R, Nieuwlaat R, Prins MH, Tieleman RG, Coelen RJ; et al. (2010). "Progression from paroxysmal to persistent atrial fibrillation clinical correlates and prognosis". J Am Coll Cardiol. 55 (8): 725–31. doi:10.1016/j.jacc.2009.11.040. PMID 20170808.
  6. ↑ Fuster V, Rydén LE, Asinger RW; et al. (2001). "ACC/AHA/ESC 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 and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology". Eur. Heart J. 22 (20): 1852–923. doi:10.1053/euhj.2001.2983. PMID 11601835. Unknown parameter |month= ignored (help)
  7. ↑ Jahangir A, Lee V, Friedman PA, Trusty JM, Hodge DO, Kopecky SL, Packer DL, Hammill SC, Shen WK, Gersh BJ (2007). "Long-term progression and outcomes with aging in patients with lone atrial fibrillation: a 30-year follow-up study". Circulation. 115 (24): 3050–6. doi:10.1161/CIRCULATIONAHA.106.644484. PMID 17548732.
  8. ↑ Wolf PA, Dawber TR, Thomas HE, Kannel WB (1978). "Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study". Neurology. 28 (10): 973–7. PMID 570666.
  9. ↑ Wattigney WA, Mensah GA, Croft JB (2002). "Increased atrial fibrillation mortality: United States, 1980-1998". Am. J. Epidemiol. 155 (9): 819–26. doi:10.1093/aje/155.9.819. PMID 11978585.
  10. ↑ Anter E, Jessup M, Callans DJ (2009). "Atrial fibrillation and heart failure: treatment considerations for a dual epidemic". Circulation. 119 (18): 2516–25. doi:10.1161/CIRCULATIONAHA.108.821306. PMID 19433768.
  11. ↑ Hart RG, Pearce LA, Aguilar MI (2007). "Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation". Ann Intern Med. 146 (12): 857–67. doi:10.7326/0003-4819-146-12-200706190-00007. PMID 17577005.
  12. ↑ Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ (2001). "Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation". JAMA. 285 (22): 2864–70. doi:10.1001/jama.285.22.2864. PMID 11401607.
  13. ↑ Mountantonakis SE, Grau-Sepulveda MV, Bhatt DL, Hernandez AF, Peterson ED, Fonarow GC (2012). "Presence of atrial fibrillation is independently associated with adverse outcomes in patients hospitalized with heart failure: an analysis of get with the guidelines-heart failure". Circ Heart Fail. 5 (2): 191–201. doi:10.1161/CIRCHEARTFAILURE.111.965681. PMID 22361078.
  14. ↑ Lloyd-Jones DM, Larson MG, Leip EP, Beiser A, D'Agostino RB, Kannel WB; et al. (2002). "Lifetime risk for developing congestive heart failure: the Framingham Heart Study". Circulation. 106 (24): 3068–72. doi:10.1161/01.cir.0000039105.49749.6f. PMID 12473553.
  15. ↑ 15.0 15.1 15.2 15.3 15.4 15.5 15.6 15.7 McManus DD, Rienstra M, Benjamin EJ (2012). "An update on the prognosis of patients with atrial fibrillation". Circulation. 126 (10): e143–6. doi:10.1161/CIRCULATIONAHA.112.129759. PMC 3678907. PMID 22949543.
  16. ↑ Watson T, Shantsila E, Lip GY (2009). "Mechanisms of thrombogenesis in atrial fibrillation: Virchow's triad revisited". Lancet. 373 (9658): 155–66. doi:10.1016/S0140-6736(09)60040-4. PMID 19135613.
  17. ↑ Li-Saw-Hee FL, Blann AD, Lip GY (2000). "A cross-sectional and diurnal study of thrombogenesis among patients with chronic atrial fibrillation". J Am Coll Cardiol. 35 (7): 1926–31. doi:10.1016/s0735-1097(00)00627-6. PMID 10841245.
  18. ↑ 18.0 18.1 18.2 Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S (2014). "Epidemiology of atrial fibrillation: European perspective". Clin Epidemiol. 6: 213–20. doi:10.2147/CLEP.S47385. PMC 4064952. PMID 24966695.
  19. ↑ Friberg L, Rosenqvist M, Lip GY (2012). "Net clinical benefit of warfarin in patients with atrial fibrillation: a report from the Swedish atrial fibrillation cohort study". Circulation. 125 (19): 2298–307. doi:10.1161/CIRCULATIONAHA.111.055079. PMID 22514252.
  20. ↑ Ott A, Breteler MM, de Bruyne MC, van Harskamp F, Grobbee DE, Hofman A (1997). "Atrial fibrillation and dementia in a population-based study. The Rotterdam Study". Stroke. 28 (2): 316–21. doi:10.1161/01.str.28.2.316. PMID 9040682.
  21. ↑ Cha MJ, Park HE, Lee MH, Cho Y, Choi EK, Oh S (2014). "Prevalence of and risk factors for silent ischemic stroke in patients with atrial fibrillation as determined by brain magnetic resonance imaging". Am J Cardiol. 113 (4): 655–61. doi:10.1016/j.amjcard.2013.11.011. PMID 24360776.
  22. ↑ van Diepen S, Bakal JA, McAlister FA, Ezekowitz JA (2011). "Mortality and readmission of patients with heart failure, atrial fibrillation, or coronary artery disease undergoing noncardiac surgery: an analysis of 38 047 patients". Circulation. 124 (3): 289–96. doi:10.1161/CIRCULATIONAHA.110.011130. PMID 21709059.
  23. ↑ Jabre P, Roger VL, Murad MH, et al. Mortality associated with atrial fibrillation in patients with myocardial infarction: a systematic review and meta-analysis. Circulation. Apr 19 2011;123(15):1587-93.
  24. ↑ Jabre P, Jouven X, Adnet F, Thabut G, Bielinski SJ, Weston SA; et al. (2011). "Atrial fibrillation and death after myocardial infarction: a community study". Circulation. 123 (19): 2094–100. doi:10.1161/CIRCULATIONAHA.110.990192. PMC 3142914. PMID 21536994. Review in: Ann Intern Med. 2011 Sep 20;155(6):JC3-13
  25. ↑ Elahi M, Hadjinikolaou L, Galiñanes M (2003). "Incidence and clinical consequences of atrial fibrillation within 1 year of first-time isolated coronary bypass surgery". Circulation. 108 Suppl 1: II207–12. doi:10.1161/01.cir.0000089188.45285.fd. PMID 12970234.
  26. ↑ Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) 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. Circulation 114 (7):e257-354. DOI:10.1161/CIRCULATIONAHA.106.177292 PMID: 16908781

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