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Cited by 67Atrial Fibrillation Management and OutcomesAcute Ischemic Stroke ManagementVenous Thromboembolism Diagnosis and Management

Management of Atrial Fibrillation in Adults: Prevention of Thromboembolism and Symptomatic Treatment

Blackshear, Joseph L., Kopecky, Stephen L., Litin, Scott C., Safford, Robert E., Hammill, Stephen C.·1996·Mayo Clinic Proceedings
DOI 10.4065/71.2.150
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Abstract

Because of its prevalence in the population and its associated underlying diseases and morbidity, atrial fibrillation (AF) is an important and costly health problem. Advancing age, diabetes, heart failure, valvular disease, hypertension, and myocardial infarction predict the occurrence of AF within a population. The management of AF is complex and involves prevention of thromboembolic complications and treatment of arrhythmia-related symptoms. Stroke occurs in 4.5% of untreated patients with AF per year. Independent risk factors for stroke in nonrheumatic patients with AF are advanced age; a history of prior embolism, hypertension, or diabetes; and echocardiographic findings of left atrial enlargement and left ventricular dysfunction. Warfarin decreases stroke by two-thirds and death by one-third; aspirin is only about half as effective overall and is insufficient therapy for those with risk factors for stroke. Options for thromboembolic prophylaxis are use of warfarin for all in whom it is safe or, alternatively, warfarin for those with risk factors and aspirin for those without risk factors. One-half of the patients with AF are 75 years of age or older. The uniform applicability and relative safety of warfarin therapy in this age-group are controversial. Specific therapy for the arrhythmia should be dictated by the need to control symptoms. Symptomatic treatments include rate-control medications and strategies designed to terminate and prevent arrhythmia recurrence. Digoxin, beta-adrenergic blockers, verapamil, and diltiazem slow excessive ventricular rates in patients with AF and may favorably manage comorbid conditions. The efficacy of anti-arrhythmic medications is only 40 to 70% per year in preventing recurrences of AF, and these agents, except amiodarone, may increase the risk of sudden death in patients with certain types of organic heart disease and AF. The use of nonpharmacologic symptomatic therapies such as atrioventricular node modification or ablation with a rate-response pacemaker or surgical intervention is increasing.

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Authors
Blackshear, J. L., Kopecky, S. L., Litin, S. C., Safford, R. E., & Hammill, S. C.
Affiliations
  • Mayo Clinic in Florida (US)
  • Mayo Clinic (US)
Corresponding author
Blackshear, Joseph L.
ORCID
Venue
Mayo Clinic Proceedings
Publisher
Elsevier BV
Published
1996-02
Volume
71
Issue
2
Pages
150-160
ISSN
0025-6196 (ISSN-L)
DOI
10.4065/71.2.150
OpenAlex
W1971493767
Cited by
67
References
69
Citations by year
2026: 1 · 2023: 1 · 2021: 1 · 2019: 1 · 2018: 1 · 2016: 1 · 2015: 1 · 2014: 1 · 2013: 4 · 2012: 2
FWCI
1.59
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Mayo Clinic Proceedings (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
  • Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
  • Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
Keywords
atrial fibrillation, thromboprophylaxis, stroke risk factors, warfarin, aspirin, anticoagulation, rate control, antiarrhythmic drugs, amiodarone, sudden death, atrioventricular node ablation, atrial fibrillation recurrence, elderly patients
MeSH terms
Adrenergic beta-Antagonists, Adult, Age Factors, Aged, Anti-Arrhythmia Agents, Aspirin, Atrial Fibrillation, Cerebrovascular Disorders, Digoxin, Diltiazem, Embolism, Humans, Hypertension, Thromboembolism, Verapamil, Warfarin, Catheter Ablation, Diabetes Complications

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