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Analysis of Therapeutic Management of Atrial Fibrillation

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Introduction

Atrial fibrillation refers to heart disease characterized by abnormal and irregular heartbeat

rates. Atrial fibrillation is considered frequently heart condition managed in critical care units of

the medical facility (Sagris et al., 2021). Atrial Fibrillation prevalence rates are estimated to be

2% of the general human population and 12% in aged populations (Staerk et al., 2017). Data

from the global burden of diseases shows that AF rates are estimated at 34 million among the

global populations in different nations (Sagris et al., 2021).

Risk factors associated with Atrial Fibrillation

a) Age

Among the risk factors of atrial Fibrillation, age is also associated with the prevalence rates of

the condition. The risk one atrial fibrillation increases as one gets old (Rodriguez et al., 2015).

Individuals aged 60 years and below and living with atrial fibrillation have a healthy living

compared to those aged above 60 years.

b) Smoking

Smoking is associated with increased rates of atrial fibrillation. Being exposed to smoking

whether active or passive smoker increases the rates of developing atrial fibrillation. When an

individual is exposed to tobacco use either during the pregnancy period or early years of child

development as a passive smoker, they are associated with a 40% risk of developing atrial

fibrillation (Dixit et al., 2016). Smoking increases the risk of getting atrial fibrillation because it
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increases myocardial ischemia hence the increase of increasing systemic catecholamine and

myocardial activities, reduction in oxygen capacity, and leading to coronary vasoconstriction.

c) Obesity

The prevalence of obesity and high body mass index is associated with atrial fibrillation and

other serious illness including myocardial infarction, diabetes mellitus, left ventricular

hypertrophy, left ventricular diastolic dysfunction, and left atrial enlargement (Sagris et al.,

2021). Increased body mass index and obesity in individuals, therefore, is a risk factors for

developing atrial fibrillation. This is because obesity increases the volume and pressure of the

left atrial, the mass of the ventricular, and pericardial fat.

d) Unhealthy lifestyle and Physical Activity

Poor health lifestyles and levels of individual physical activities are associated with the

prevalence of atrial fibrillation (AF). Increased rates of AF are linked to a high level of physical

activity (Mohanty et al., 2016). The risk of atrial fibrillation decreases with the increase in

cardiorespiratory fitness. For instance, (Qureshi et al., 2015) established that individuals with

low levels of cardiorespiratory fitness are at high risk of atrial fibrillation compared to those with

maximum fitness.

Individuals with high physical activity levels are associated with a high risk for atrial

fibrillation in comparison to those with low physical activity levels. For instance, individuals

such as athletes who have high-intensity levels of physical activity are linked to atrial fibrillation,

and those who do not participate in sports activities (Calvo et al., 2016).
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Therapeutic Management of Atrial Fibrillation

Atrial fibrillation diagnosis

Before coming up with measures and treatment plans for atrial fibrillation, the first step is to

do a diagnosis of the health condition to determine the type of medication that will be employed

in the management of the condition. Atrial fibrillation signs and symptoms include palpitations

dyspnea, chest pain, dizziness, and fatigue (Palano et al., 2020). During diagnosis, transthoracic

echocardiography (Developed with the Special Contribution of the European Heart Rhythm et

al.) is only applied to patients considered to be placed under long-term management of the

condition, those to be placed under rhythm control strategy, those patients that need stratification

for antithrombotic therapy and for those who have high worse state of the condition.

Atrial fibrillation treatment measures.

i. Rhythm and rate control

This is the treatment management of atrial fibrillation which entails the use of

pharmacological cardioversion (PCV), electrical cardioversion (ECV), surgical atrial debulking

(MAZE), and catheter ablation such as pulmonary PVI (Kakar et al., 2007). Pharmacological and

electrical cardioversion is used as treatment measures in a patient with the early stages of the

onset of the disease while electrical cardioversion is applied to patients with atrial fibrillation at

later stages of the condition.

In rhythm and rate control of atrial fibrillation, the condition is classified based on prevalence

duration and management measures are taken under consideration of the atrial fibrillation period
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in the individual. The objectives of using cardioversion are to minimize the disease symptoms

and gain maximum control rate of the condition in the patient. The decision to use rhythm and

rate control management is reached by the doctors and the patients, rate control entails the

applications of atrioventricular nodal blockade including b-blockers, calcium channel blockers,

and digitalis in an attempt of limiting the atrioventricular conduction (Morin et al.).

ii. Antithrombotic therapy

The therapy is aimed at preventing ischemic stroke and thromboembolic events. To prevent

the risk of stroke, anticoagulants are used. The use of anticoagulation in the management of atrial

fibrillation depends on the strategy of treatment being used i.e. rhythm and rate control.

antithrombotic therapy is used in stroke prevention in the case where the strategy chosen was

rhythm control. It is also utilized in the prevention of thromboembolic events due to

cardioversion. The use of warfarin and aspirin has been shown to reduce the risk of ischemic

stroke and thromboembolic events. Heparin is administered in patients with acute atrial

fibrillation and in cases where cardioversion can be avoided, in such cases warfarin is

administered to the patient after cardioversion has been conducted and within a period lapse of

almost one month (Kakar et al., 2007).

Anticoagulation effectiveness in ischemic stroke rate reduction is the same for both patients

with paroxysmal and permanent atrial fibrillation conditions. Patients with paroxysmal and

permanent atrial fibrillation exhibit similar rates of stroke annually and have asymptomatic

recurrences exposing them to the risk of recurrent atrial fibrillation without being recognized.

The use of anticoagulation on patients with paroxysmal atrial fibrillation is based on the risks of
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stratification, but permanent atrial fibrillation is based on the occurrences and period of atrial

fibrillation.

iii. AV nodal ablation and pacing

The process involves the ablation of the atrioventricular node and the insertion of a permanent

pacemaker to provide heart rate control. This procedure is performed on patients with failed

pharmacologic treatment agents or who cannot sustain the treatment agents due to hypotension.
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https://doi.org/10.1161/circresaha.117.309732