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Early management of atrial fibrillation to prevent cardiovascular complications.

Publication ,  Journal Article
Nattel, S; Guasch, E; Savelieva, I; Cosio, FG; Valverde, I; Halperin, JL; Conroy, JM; Al-Khatib, SM; Hess, PL; Kirchhof, P; De Bono, J ...
Published in: Eur Heart J
June 7, 2014

Atrial fibrillation (AF) is generally considered a progressive disease, typically evolving from paroxysmal through persistent to 'permanent' forms, a process attributed to electrical and structural remodelling related to both the underlying disease and AF itself. Medical treatment has yet to demonstrate clinical efficacy in preventing progression. Large clinical trials performed to date have failed to show benefit of rhythm control compared with rate control, but these trials primarily included patients at late stages in the disease process. One possible explanation is that intervention at only an early stage of progression may improve prognosis. Evolving observations about the progressive nature of AF, along with the occurrences of major complications such as strokes upon AF presentation, led to the notion that earlier and more active approaches to AF detection, rhythm-reversion, and maintenance of sinus rhythm may be a useful strategy in AF management. Approaches to early and sustained rhythm control include measures that prevent development of the AF substrate, earlier catheter ablation, and novel antiarrhythmic drugs. Improved classifications of AF mechanism, pathogenesis, and remodelling may be helpful to enable patient-specific pathophysiological diagnosis and therapy. Potential novel therapeutic options under development include microRNA-modulation, heatshock protein inducers, agents that influence Ca(2+) handling, vagal stimulators, and more aggressive mechanism-based ablation strategies. In this review, of research into the basis and management of AF in acute and early settings, it is proposed that progression from paroxysmal to persistent AF can be interrupted, with potentially favourable prognostic impact.

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Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

June 7, 2014

Volume

35

Issue

22

Start / End Page

1448 / 1456

Location

England

Related Subject Headings

  • Risk Factors
  • Randomized Controlled Trials as Topic
  • Middle Aged
  • Humans
  • Early Diagnosis
  • Disease Progression
  • Catheter Ablation
  • Cardiovascular System & Hematology
  • Cardiovascular Diseases
  • Atrial Remodeling
 

Citation

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Nattel, S., Guasch, E., Savelieva, I., Cosio, F. G., Valverde, I., Halperin, J. L., … Camm, A. J. (2014). Early management of atrial fibrillation to prevent cardiovascular complications. Eur Heart J, 35(22), 1448–1456. https://doi.org/10.1093/eurheartj/ehu028
Nattel, Stanley, Eduard Guasch, Irina Savelieva, Francisco G. Cosio, Irene Valverde, Jonathan L. Halperin, Jennifer M. Conroy, et al. “Early management of atrial fibrillation to prevent cardiovascular complications.Eur Heart J 35, no. 22 (June 7, 2014): 1448–56. https://doi.org/10.1093/eurheartj/ehu028.
Nattel S, Guasch E, Savelieva I, Cosio FG, Valverde I, Halperin JL, et al. Early management of atrial fibrillation to prevent cardiovascular complications. Eur Heart J. 2014 Jun 7;35(22):1448–56.
Nattel, Stanley, et al. “Early management of atrial fibrillation to prevent cardiovascular complications.Eur Heart J, vol. 35, no. 22, June 2014, pp. 1448–56. Pubmed, doi:10.1093/eurheartj/ehu028.
Nattel S, Guasch E, Savelieva I, Cosio FG, Valverde I, Halperin JL, Conroy JM, Al-Khatib SM, Hess PL, Kirchhof P, De Bono J, Lip GYH, Banerjee A, Ruskin J, Blendea D, Camm AJ. Early management of atrial fibrillation to prevent cardiovascular complications. Eur Heart J. 2014 Jun 7;35(22):1448–1456.
Journal cover image

Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

June 7, 2014

Volume

35

Issue

22

Start / End Page

1448 / 1456

Location

England

Related Subject Headings

  • Risk Factors
  • Randomized Controlled Trials as Topic
  • Middle Aged
  • Humans
  • Early Diagnosis
  • Disease Progression
  • Catheter Ablation
  • Cardiovascular System & Hematology
  • Cardiovascular Diseases
  • Atrial Remodeling