Elsevier

Heart Failure Clinics

Volume 6, Issue 2, April 2010, Pages 187-200
Heart Failure Clinics

Genetics basis of other phenotypic components of heart failure
Atrial Fibrillation in Congestive Heart Failure

https://doi.org/10.1016/j.hfc.2009.11.001Get rights and content

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Epidemiology

AF is the most common arrhythmia seen in clinical practice and is responsible for significant morbidity.1 More than 2.3 million individuals in the United States currently have AF,2 and as many as 5.6 to 12.1 million individuals are projected to be affected by 2050.2, 3 The lifetime risk of developing AF after age 40 is 26% for men and 23% for women.4 The presence of AF confers a fivefold increased risk of stroke,5 a significantly increased risk of dementia,6 and an almost twofold increased risk

Pathophysiology of atrial fibrillation in congestive heart failure

The pathophysiologic basis of AF is complex and incompletely understood.38 Initial mechanistic explanations for AF cited reentry as a principal factor.39, 40, 41, 42 The multiple wavelet hypothesis, proposed by Moe and Abildskov,41 stated that the development of AF depended on the perpetuation of a sufficient number of “randomly wandering wavelets” created as a normal occurrence due to heterogeneous repolarization. The hypothesis maintained that adequate atrial mass, short refractory periods,

Thromboembolism Prophylaxis

Thromboembolism prophylaxis, ventricular rate control, and restoration of sinus rhythm, when indicated, are the goals of AF therapy.1 The risk of cerebral thromboembolism in patients with AF is increased in those with CHF.31 Annual stroke risk can be estimated using validated scoring schemes,31, 120 and guidelines provide a recommended approach to the prevention of thromboembolism in patients based on their underlying risk. Generally, warfarin is advisable for the prevention of ischemic

Summary

AF and CHF share many risk factors, frequently coexist, and identify individuals at high risk of cardiovascular morbidity. The pathophysiologic mechanisms of AF in patients with CHF are complex and potentially involve elements of reentry, triggered activity, and enhanced automaticity. Therefore, it is unlikely that a treatment strategy aimed at any one of these mechanisms alone will restore sinus rhythm. A rhythm control strategy consisting of antiarrhythmic drugs and electrical cardioversion

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    Dr Lubitz is supported by an NIH training grant (5T32HL007575). This work was supported by grants from the NIH: HL092577 to Drs Ellinor and Benjamin; AGO 28321 and RC1-HL01056 to Dr Benjamin; and DA027021 to Dr Ellinor. Dr Ellinor is a consultant to Sanofi-Aventis.

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