Page 18 - ADD-ON ABLATION SURGERY IN PATIENTS WITH ATRIAL FIBRILLATION

Chapter 1
activity into AF85. On this basis, it has been suggested that selective elimination of ganglionic plexuses might attenuate the occurrence of AF.
Types of atrial fibrillation
Management of patients withAF requires knowledge of its pattern of presentation86 (first diagnosed, paroxysmal, persistent, long-standing, and permanent AF), underlying conditions, and decisions about restoration and maintenance of sinus rhythm (SR), control of the ventricular rate, and antithrombotic therapy.
1. First diagnose AF, irrespective of the duration of the arrhythmia or the presence and severity of AF-related symptoms.
2. Paroxysmal AF is self-terminating, usually within 48 h.
3. Persistent AF is present when an AF episode either lasts >7 days or requires termination by cardioversion, either with drugs or by direct
current cardioversion.
4. Long-standing persistent AF has lasted for ≥1 year when it is decided to
adopt a rhythm control strategy.
5. Permanent AF is said to exist when the presence of the arrhythmia is
accepted by the patient (and physician).
This classification is useful for clinical management of AF patients, especially when AF-related symptoms are also considered. Many therapeutic decisions require careful consideration of additional individual factors and co-morbidities.
Treatment of atrial fibrillation
Pharmacological therapy
The efficacy of therapy has been primarily based on morbidity and mortality: for symptom control anti-arrhythmic drugs and cardioversion are used, but breakthrough arrhythmias and side effects of the drugs happen frequently86. Antiarrhythmic drug therapy is the first-line treatment for patients with paroxysmal and persistent AF based on current guidelines86-87. Prevention of AF-related complications rely on antithrombotic therapy, control of ventricular rate, and adequate therapy of concomitant cardiac diseases. However, available drug therapy has major limitations, including incomplete effectiveness, cardiac and extracardiac toxicity and risk of life-threatening proarrhythmic complications (antiarrhythmic agents), and bleeding (anticoagulants) 88-91.
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