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

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==Overview==
==Overview==
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==Complications==
==Complications==
Due to the lack of coordination of atrial activation, there is a decline in the mechanical pumping action of the [[atrium]]. <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>The decline in mechanical function of the atrium may or may not lead to inadequate filling of the ventricle(s) depending upon the importance of the atrial kick or atrial contribution to ventricular filling in a given patient.  In patients with a stiff left ventricle (such as patients with hypertension), the atrial kick may be critical to achieve adequate ventricular filling.  In addition, atrial fibrillation may worsen the signs and symptoms of [[congestive heart failure]], particularly among those patients with [[valvular heart disease]], due to a reduction in the atrial kick needed to fill the [[left ventricle]].
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> However, many patients do have additional risk factors and AF is a leading cause of stroke.<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>
 
*Reduced mechanical pumping action of the [[atrium]]:
Patients with atrial fibrillation usually have a significantly increased risk of [[stroke]] (up to 7 times that of the general population). Stroke risk increases during AF because blood may pool and form clots in the poorly contracting atria and especially in the [[left atrial appendage]] (LAA). The level of increased risk of stroke depends on the number of additional risk factors. If the AF patient has none, the risk of stroke is similar to that of the general population.<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> However, many patients do have additional risk factors and AF is a leading cause of stroke.<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>
**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. 
Chronic AF is associated with a 1.5 to 1.9 fold increased risk of death, often times due to thromboembolic events.<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>
*Worsening the signs and [[symptoms]] of [[congestive heart failure]].
 
**Particularly among [[patients]] with [[valvular heart disease]]
If left untreated, the chronic [[tachycardia]] associated with atrial fibrillation may result in a tachycardia mediated [[cardiomyopathy]].
**Due to the reduced [[atrium|atrial kick]] needed to fill the [[ventricle|left ventricle]].
*Increased [[stroke]] risk
**[[Patients]] with [[atrial fibrillation]] usually have a significantly increased risk of [[stroke]] (up to 7 times that of the general population).
**[[Stroke]] risk increases during [[AF]] because [[blood]] may pool and form [[Thrombus|clots]] in the poorly contracting [[atrium]] and especially in the [[Left atrium|left atrial appendage]] ([[Left atrium|LAA]]).
**One in every 6 [[strokes]] occurs in [[atrial fibrillation]] [[patients]].
**The level of increased risk of [[stroke]] depends on the number of additional [[risk factors]]. If the [[AF]] [[patient]] has none, the risk of [[stroke]] is similar to that of the general population.
**The following table is a summary of [[stroke]] risk in different population: <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><ref name="pmid22514252">{{cite journal| author=Friberg L, Rosenqvist M, Lip GY| title=Net clinical benefit of warfarin in patients with atrial fibrillation: a report from the Swedish atrial fibrillation cohort study. | journal=Circulation | year= 2012 | volume= 125 | issue= 19 | pages= 2298-307 | pmid=22514252 | doi=10.1161/CIRCULATIONAHA.111.055079 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22514252  }} </ref>
<br>
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! style="width: 300px; background: #4479BA;" | {{fontcolor|#FFF|200px}}
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Region
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Year
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Risk of Stroke
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | The United States
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | 1992
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | 48 per 1,000 person
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | The United States
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | 2007
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | 17 per 1,000 person
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Sweden
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | 2012
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | 25 per 1,000 person
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | France
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | 2013
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | 10 per 1,000 person
|-
|}
{{clear}}
*Death
**[[Chronic (medical)|Chronic]] [[AF]] is associated with a 1.5 to 1.9 fold increased risk of death, often times due to thromboembolic events.
*[[Cardiomyopathy]]
**If left untreated, the [[Chronic (medical)|chronic]] [[tachycardia]] associated with [[atrial fibrillation]] may result in a [[tachycardia]] mediated [[cardiomyopathy]].


==Prognosis==
==Prognosis==
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.
*After introduction of [[anticoagulant]] [[treatment]] rate of [[stroke]] and consequently risk of death have been decreased.<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>
* The [[CHADS Score]] can estimate this rate with greater certainty
*Based on numerous studies the improved [[prognosis]] of [[atrial fibrillation]] has been demonstrated after [[anticoagulant]] [[treatment]].
:*[[CHADS Score|CHADS2 Score]]
*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>
:*[[CHA2DS2-VASc Score]]
*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]].
:*[[HAS-BLED score]]
** The [[CHADS Score]] can estimate this rate with greater certainty:
***[[CHADS Score|CHADS2 Score]]
***[[CHA2DS2-VASc Score]]
***[[HAS-BLED score]]
*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]].
===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 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]].
===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
* 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%.
* [[Relative risk]] in the Regional Heart study was 2.3%.
* In the ALFA study follow up, [[patients]] with [[atrial fibrillation]] were found to have a 2.4% [[incidence]] of [[thromboembolism]] with the mean being 8.6 months of follow-up time.<ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 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. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref>


* One in every 6 strokes occurs in atrial fibrillation patients
* The rate of brain [[ischemia]] in conjunction with 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 nonrheumatic atrial fibrillation


====Observational Studies====
===Mortality===
* 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
* The [[relative risk]] for stroke in the Whitehall study was 6.99%
* Relative risk in the Regional Heart study was 2.3%
* In the ALFA study follow up, patients with atrial fibrillation were found to have a 2.4% incidence of [[thromboembolism]] with the mean being 8.6 months of follow-up time<ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 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. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref>


==Atrial Fibrillation in the Setting of STEMI==
*[[Atrial fibrillation]] is associated with a 1.5 to 1.9 fold increase in the risk of death.<ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 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. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</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 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 basis for this increase risk of mortality is not clear.  Most likely it reflects the fact that atrial fibrillation is a marker of impaired LV function, but it may also reflect the loss of the atrial kick or the hazard associated with triple therapy with [[aspirin]], [[clopidogrel]], and [[coumadin]].
*The [[mortality rate]] of [[patients]] with [[atrial fibrillation]] is nearly double that of [[patients]] with normal [[sinus rhythm]]. This increase is due not only to [[atrial fibrillation]] but this also associated with the severity of the underlying [[disease]], and is often due to [[thromboembolism|thromboembolic events]].<ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 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. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref>  
 
*The administration of drugs aimed at rate control alone offers no survival advantage over the use of rate control along with [[anticoagulation]] as demonstrated in the AFFIRM trial.<ref>Wyse DG, Waldo AL, DiMarco JP, Domanski MJ, Rosenberg Y, Schron EB, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. Dec 5 2002;347(23):1825-33.</ref>
===Mortality===
Atrial fibrillation is associated with a 1.5 to 1.9 fold increase in the risk of death.  The mortality rate of patients with atrial fibrillation is nearly double that of patients with normal [[sinus rhythm]]. This increase is due not only to atrial fibrillation but this also associated with the severity of the underlying disease, and is often due to [[thromboembolism|thromboembolic events]].<ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 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. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref> The administration of drugs aimed at rate control alone offers no survival advantage over the use of rate control along with [[anticoagulation]] as demonstrated in the AFFIRM trial.<ref>Wyse DG, Waldo AL, DiMarco JP, Domanski MJ, Rosenberg Y, Schron EB, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. Dec 5 2002;347(23):1825-33.</ref>


==References==
==References==

Revision as of 19:46, 27 July 2021
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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

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.

Natural History

Complications

The following are complications of atrial fibrillation:[5][6] However, many patients do have additional risk factors and AF is a leading cause of stroke.[7][1][8]


200px 200px 200px
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

Observational Studies


Mortality

References

  1. ↑ 1.0 1.1 1.2 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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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)
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ 9.0 9.1 9.2 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.
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ 12.0 12.1 12.2 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
  13. ↑ Wyse DG, Waldo AL, DiMarco JP, Domanski MJ, Rosenberg Y, Schron EB, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. Dec 5 2002;347(23):1825-33.

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