| Atrial fibrillation. | |
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MedLine Citation:
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PMID: 17309423 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The incidence and prevalence of atrial fibrillation are increasing because of both population ageing and an age-adjusted increase in incidence of atrial fibrillation. Deciding between a rate control or rhythm control approach depends on patient age and comorbidities, symptoms and haemodynamic consequences of the arrhythmia, but either approach is acceptable. Digoxin is no longer a first-line drug for rate control: beta-blockers and verapamil and diltiazem control heart rate better during exercise. Anti-arrhythmic drugs have only a 40%-60% success rate of maintaining sinus rhythm at 1 year, and have significant side effects. The selection of optimal antithrombotic prophylaxis depends on the patient's risk of ischaemic stroke and the benefits and risks of long-term warfarin versus aspirin, but is independent of rate or rhythm control strategy. Ischaemic stroke risk is best estimated with the CHADS2 score (Congestive heart failure, Hypertension, Age > or = 75 years, Diabetes, 1 point each; prior Stroke or transient ischaemic attack, 2 points). For patients with valvular atrial fibrillation or a CHADS(2) score > or = 2, anticoagulation with warfarin is recommended (INR 2-3, higher for mechanical valves) unless contraindicated or annual major bleeding risk > 3%. Aspirin or warfarin may be used when the CHADS(2) score = 1. Aspirin, 81-325 mg daily, is recommended in patients with a CHADS(2) score of 0 or if warfarin is contraindicated. Stroke rate is similar for paroxysmal, persistent, and permanent atrial fibrillation, and probably for atrial flutter. |
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Authors:
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Caroline Medi; Graeme J Hankey; Saul B Freedman |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: The Medical journal of Australia Volume: 186 ISSN: 0025-729X ISO Abbreviation: Med. J. Aust. Publication Date: 2007 Feb |
Date Detail:
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Created Date: 2007-02-20 Completed Date: 2007-03-20 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0400714 Medline TA: Med J Aust Country: Australia |
Other Details:
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Languages: eng Pagination: 197-202 Citation Subset: IM |
Affiliation:
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Department of Cardiology, Concord Repatriation General Hospital, University of Sydney, Sydney, NSW. ben@gmp.usyd.edu.au. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Age Factors Anti-Arrhythmia Agents / therapeutic use Anticoagulants / therapeutic use Atrial Fibrillation / therapy* Fibrinolytic Agents / therapeutic use Heart Rate / drug effects Humans Myocardial Contraction / drug effects Risk Factors Stroke / prevention & control |
| Chemical | |
Reg. No./Substance:
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0/Anti-Arrhythmia Agents; 0/Anticoagulants; 0/Fibrinolytic Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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