Center for Arrhythmia & Atrial Fibrillation

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Ash Jain, MD, FACC
Thirupathi Reddy, MD, FACC
Adil Irani, MD
Sanjay Bindra, MD, FACC
Lay Hwa Lou, MD
Seema Rikhy, MD
Simin Siddiq, MD
Shaista Shah, MD
Hui Zheng, MD
Sylvia Hoang, MD
Victor Maceda, MD
Archana Bindra, MD
Shakir Hyder, MD
Scott Kramer, MD
Uma Kantamuneni, MD
Micheal Heinrich, MD
Harry Lifschutz, MD
Hae Jin Lim

Center for Arrhythmia and Atrial Fibrillation Management

Atrial fibrillation is the most common sustained arrhythmia, increases with age, and presents with a wide spectrum of symptoms and severity. Paroxysmal, persistent, and permanent forms require very individualized approaches to management. New information about electrical and anatomic remodeling emphasizes the importance of time-related thrombogenicity and progressive interference with mechanical function of the atria and ventricles. The most important aspect of diagnosis is risk stratification with respect to risk of thromboembolism. The general goals in treatment are, in order of importance: prevention of thromboemboli, control of ventricular response, restoration of sinus rhythm, and maintenance of sinus rhythm by preventing recurrences. This review focuses on the above issues. The therapeutic choices are discussed under each category. Antiarrhythmic drugs, radiofrequency ablation techniques, and device therapy are reviewed with respect to prevention of recurrent atrial fibrillation.

Much has been learned in the last decade regarding the mechanisms that underlie the initiation and perpetuation of atrial fibrillation. For nearly a century, it has been known that atrial fibrillation exists in the presence of various forms of heart disease in which stretching and scarring of the atrial myocardium appear to promote, in some way, electrical disorganization of atrial depolarization. It has also been recognized that atrial fibrillation occurs in individuals without overt heart disease, but the mechanisms are only now becoming understood. In such individuals, with “lone” atrial fibrillation, certain precursor arrhythmias are sometimes found—especially macro-reentrant atrial flutter, focal atrial tachycardias, and reentrant supraventricular tachycardias, such as atrioventricular (A-V) nodal reentrant tachycardia and orthodromic reciprocating tachycardia.

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