Straightforward answers to your questions about living with atrial fibrillation—the most common sustained cardiac arrhythmia—with expert medical guidance on the newest treatments, based on recently updated clinical practice guidelines.

Atrial Fibrillation: The Latest Management Strategies

Atrial Fibrillation:
The Latest Management Strategies

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If you've ever run up a flight of stairs, chased a tennis ball across the court or reacted in fright at a scary movie, you know what a pounding heart feels like ...

But for the 2.7 million Americans who suffer from atrial fibrillation (AF or AFib), a racing heart is a way of life. Simple tasks like getting out of bed in the morning or rising from a chair can cause dizziness, weakness, shortness of breath or heart palpitations. For these people, AF severely impairs quality of life—and even when symptoms stemming from AF are mild, the disorder can seriously impact health, increasing the risk of stroke and heart failure.

AF can be a debilitating, even deadly, condition. Fortunately, it can be successfully managed — but there are various approaches for treating AF or preventing a recurrence. How do you and your doctor choose which approach is right for you?

If you or a loved one has AF, there are so many questions: Do I need an oral anticoagulant to prevent a stroke ... how effective (and safe) are the new oral anticoagulants that I see advertised ... should I be taking medication to control my heart rate ... will my symptoms respond to cardioversion ... if I need an antiarrhythmic drug to control AF episodes, which one should I take ... when is an ablation procedure appropriate ... and more.

It's critically important to learn everything you can now—so you can partner with your doctor effectively, ask the right questions and understand the answers.

That's why the University of California, Berkeley School of Public Health has engaged a team of top atrial fibrillation experts, Dr. Hugh Calkins, Dr. Ronald Berger, Dr. Gregory Marcus and Dr. Pate D Thomson, to bring you Atrial Fibrillation: The Latest Management Strategies. This authoritative Special Health Report contains vital information you won't find in any other single source.

  • Gregory Marcus, M.D.  Dr. Marcus is the inaugural Endowed Professor in Atrial Fibrillation Research at the University of California, San Francisco. In addition to having an active practice as a cardiac electrophysiologist seeing patients with arrhythmias and performing catheter ablations and implantations of pacemaker and implantable cardioverter-defibrillators, Dr. Marcus serves as the Director of Clinical Research for the Division of Cardiology at UCSF. Dr. Marcus has an active research program, with a central theme related to atrial fibrillation.
  • Hugh Calkins, M.D.  Dr. Calkins is the Nicholas J. Fortuin, M.D., Professor of Cardiology, Professor of Pediatrics, and Director of the Arrhythmia Service, the Electrophysiology Lab, and the Atrial Fibrillation Center at The Johns Hopkins Hospital. He has clinical and research interests in the treatment of cardiac arrhythmias with catheter ablation, the role of device therapy for treating ventricular arrhythmias, the evaluation and management of syncope, and the study of arrhythmogenic right ventricular dysplasia. Dr. Calkins has authored more than 500 manuscripts and book chapters, and he is a member of the editorial boards of five major cardiology journals. He was lead author of the 2007 and 2012 HRS/EHRA/ECAS Consensus Documents on Catheter and Surgical Ablation of Atrial Fibrillation, and more recently he was a member of the writing committee for the updated atrial fibrillation guidelines issued jointly in 2014 by the American College of Cardiology, the American Heart Association, and the Heart Rhythm Society. In 2013 Dr. Calkins served as president of the Heart Rhythm Society, an international organization of more than 5,800 specialists in heart rhythm disorders.
  • Ronald Berger, M.D., Ph.D.  Dr. Berger is a Professor of Medicine and Biomedical Engineering at Johns Hopkins University.  He is Director of the Electrophysiology Fellowship Program and Co-director of the Electrophysiology Service at The Johns Hopkins Hospital. He serves on the editorial boards of three major journals in the cardiovascular field, has authored more than 250 articles and book chapters, and holds over 30 patents on methods and devices used in electrophysiology diagnosis and treatment. Along with Dr. Hugh Calkins, Dr. Berger and his colleagues perform approximately 3,500 electrophysiology procedures and 500 atrial fibrillation ablation procedures each year.
  • Pate D Thomson, M.D.  Dr Thomson is founding physician for the Cardiology Division at Alta Bates Medical Center and for 19 years served as Chief of this department. He is a fellow in the American College of Cardiology and Clinical Professor of Medicine (emeritus) at UCSF.  He taught many years at the Joint Medical Program at UC Berkeley and at UCSF. He is a clinician with long experience treating atrial fibrillation and other cardiac arrhythmias and caring for patients with a broad spectrum of cardiac disease. During this time he witnessed the emergence of cardiac electrophysiology as a clinical specialty and the many advancements in arrhythmia management.

Recently, the American Heart Association, the American College of Cardiology and the Heart Rhythm Society jointly issued updated and revised clinical practice guidelines for managing AF. Atrial Fibrillation: The Latest Management Strategies makes use of these new guidelines to provide you with current information on the newest drugs, treatments options and research data.

"I feel like my heart is going to jump out of my chest ..."

An arrhythmia is an abnormality in the timing or pattern of the heartbeat, causing the heart to beat too rapidly, too slowly, or irregularly. Sounds pretty straightforward, but there's a lot we don't know about why the heart rhythm goes awry ... or the best way to treat it.

In Atrial Fibrillation: The Latest Management Strategies, we focus on what we DO know. In page after page of this comprehensive report, we address your most serious concerns about living with AF, such as:

  • What are the common symptoms of AF?
  • How is AF detected?
  • I don't have any symptoms. Is my problem definitely AF?
  • What tests may my doctor recommend to diagnose me and determine if AF is causing my symptoms?
  • What questions will my doctor ask about my condition? How do I prepare for my visit? What questions should I ask my doctor?
  • Can drinking alcohol trigger or worsen AF? What about extra weight? What about drinking caffeine?
  • Is every person who has AF at risk for a stroke?
  • What tests will my doctor recommend to assess whether AF is causing my symptoms?
  • If my doctor suspects AF, will I have to wear an implantable or event monitor to be sure?
  • Should I get a second opinion? Under what circumstances should I consider a second opinion?
  • Why does AF often show up later in life?
  • What would you recommend to the older patient—75 and older—who has AF but no bothersome symptoms?
  • What do you recommend for the person with longstanding persistent AF?
  • Is the AF experienced by an otherwise healthy person different from that of a person with underlying heart disease or other health issues?
  • What are the differences among: paroxysmal AF, persistent AF and longstanding persistent AF?
  • What options are available for controlling my AF symptoms?
  • What if antiarrhythmic medication fails to suppress AF episodes?

Anticoagulation Therapy: What You Should Know

While AF is generally not life threatening, for some patients it can increase the likelihood of blood clots forming in the heart. And if a clot travels to the brain, a stroke will result. Anticoagulation therapy is used to prevent blood clot formation in people with AF—but it is no longer restricted to the mainstay blood thinner warfarin (Coumadin).

Four new anticoagulants have now been approved by the FDA—dabigatran etexilate (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), and (most recently) edoxaban (Savaysa). Atrial Fibrillation: The Latest Management Strategies discusses the pros and cons of each so you'll be in a position to discuss your drug choices with your doctor. In addition, you'll find answers to key questions about anticoagulation therapy, including:

  • Who can benefit from anticoagulation therapy?
  • Why is anticoagulation therapy with warfarin still necessary for some people with AF?
  • How do you decide between warfarin and one of the newer anticoagulants in newly diagnosed patients?
  • Do the new drugs have any downsides in comparison with warfarin?
  • What's the CHA2DS2-VASc score and how is it used?
  • Why is it so challenging to keep within therapeutic range with warfarin?
  • What happens if my INR is too high?
  • Is there still a role for antiplatelet therapy in AF-related stroke prevention?
  • Is there a point when a patient can stop anticoagulant therapy?

Symptom Control: The Science of Rate and Rhythm Control

Taking into account your age, the severity of your symptoms, and how long you have had AF, you and your doctor will consider two key management strategies: heart rate and heart rhythm control. In Atrial Fibrillation: The Latest Management Strategies, you'll read an in-depth discussion of the effects of rate versus rhythm control for AF—and who the appropriate candidates are for each strategy:

  • What have we learned from the AFFIRM study, and how has this knowledge affected the management of AF?
  • What are the appropriate medications for rate control?
  • What is catheter ablation of the AV (atrioventricular) node?
  • Why is cardioversion needed?
  • Are there different types of cardioversion?
  • What is chemical cardioversion? What is electrical cardioversion?
  • Can medication be used to convert the heart back to normal sinus rhythm?
  • Which antiarrhythmic drugs are most commonly used to achieve and maintain normal heart rhythm?
  • When is catheter ablation of AF an option—and how it is performed?
  • Who are the best candidates for catheter ablation of AF?
  • What can be done if catheter ablation isn’t successful?

There's More to Atrial Fibrillation: The Latest Management Strategies, much more.

We explain surgical ablation of AF, a procedure performed through small incisions in the chest wall ... discuss when it's appropriate to seek a second opinion ... take a close look at strokes and explain the warning signs and differences among ischemic, thrombotic, embolic and hemorrhagic strokes ... provide a chart of current medications used in stroke prevention ... detail the guidelines for long-term use of antiarrhythmia drugs ... and include an arrhythmia glossary of key AF terms used by electrophysiologists and cardiologists.

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Atrial Fibrillation: The Latest Management Strategies is published by the University of California, Berkeley, School of Public Health. This publication is part of an outgrowth of the School’s commitment to help improve the health and wellness of our community of readers by publishing expert advice on prevention, diagnosis and treatment for a wide range of ailments and disorders. We provide trusted, authoritative health guidance from leading physicians and researchers at America’s top medical centers and hospitals.

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