Atrial Fibri PDF

Preface

Atrial fibrillation is by far the most frequently diagnosed cardiac arrhythmia in humans, accounting for tens of thousands of hospital admissions and millions of doctor visits. It is responsible for significant morbidity and mortality independent of the myriad of disease states with which it commonly coexists. Though given a common appellation, what we call atrial fibrillation represents a cornucopia of diseases extending from a focally activated pulmonary vein generator in patients with normal hearts to the diffuse degenerative disease process seen in the very old. It is this diversity of mechanism, combined with our primitive knowledge of its pathophysiology, which has rendered this arrhythmia so resistant to a myriad of interventions. It is the rare patient who can be ‘‘cured.'' For the vast majority, palliation is the goal, whether achieved with drugs or nonpharmacological therapy. The appropriate use of warfarin anticoagulation has had a positive impact on stroke, the most feared complication of the disease, but widespread implementation remains a thorny issue.

Given these facts, it is not surprising that we are in the midst of a massive effort to improve therapy and outcomes of patients stricken with atrial fibrillation. This includes symptom relief with the development of new and improved drugs for suppression of atrial fibrillation, better methods of rate control and anticoagulation, and the advent of several novel nonpharmacological therapies. The field is fast-moving and the information highly complex. Thus there is a need for a compendium, digestible by physicians in practice, in which the very latest data are adequately but succinctly summarized. Since information presented in bookform can become outdated soon after publication, we organized this bookin such a way as to make the time to publication short and to allow for a rapid preparation of subsequent editions.

This bookis organized along traditional lines, moving from general epidemiological information through a discussion of pathophysiology and then several forms of management. However, for each chapter, we sought to enlist contributors who are working at the cutting edge of their discipline. They were given explicit instructions to include only new and evolving information from recent trials and to avoid more conventional dissertations. We requested that the new information, however, be placed in clinical context, with realistic appraisals of the potential applicability of each new therapy.

We believe that we have succeeded in assembling a bookthat should be useful to clinical scientists, arrhythmologists, practicing cardiologists and internists, cardiac surgeons, physician extenders, physicians-in-training, nurses, and students. Since it is our intention to update this information fairly often and on a regular basis, we welcome constructive criticism and suggestions for new material. Our ultimate goal is to create a renewable source of solid information in an accessible format so as to keep the medical public current in all of the many aspects of caring for patients with this very common arrhythmia.