- Atrial fibrillation: when and how to treat?
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Young Keun On
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Cardiovasc Prev Pharmacother. 2024;6(1):1-7. Published online January 26, 2024
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DOI: https://doi.org/10.36011/cpp.2024.6.e4
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 Abstract
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- Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia, characterized by an irregular and rapid beating of the atria, which results in a loss of effective atrial contraction. The estimated prevalence of AF in the general population is approximately 0.4%. Research on the incidence of AF indicates a significant increase with age. AF presents a significantly higher risk of stroke compared to normal sinus rhythm, with the risk increasing approximately fivefold. It is estimated that around 5% of AF patients suffer a stroke annually. Roughly 20% to 25% of thromboembolic strokes can be attributed to AF, and AF is also associated with a twofold increase in overall mortality. The goals of AF treatment are symptom relief, restoration of normal cardiac function, prevention of thromboembolism, and reduction in mortality. Therefore, the treatment principles can be summarized into three categories: thromboembolism prevention, rate control, and rhythm control. In the treatment of AF, the first step should be to identify and eliminate any underlying causes or triggers. Caution should be exercised regarding the potential for drug-induced arrhythmias or extracardiac side effects. Safety considerations should take precedence over efficacy when selecting antiarrhythmic drugs. Nonpharmacological treatment methods are employed when anti-arrhythmic drug therapy alone is insufficient, particularly in relatively young individuals (under 70 years) without preexisting heart disease, who have experienced frequent transitions from atrial premature contractions or AF instigated by atrial premature contractions. Monitoring the patient's progress is vital, with a focus on comprehensive care for patients with AF.
- Dose Selection of Non-Vitamin K Antagonist Oral Anticoagulants in Korean Patients with Non-Valvular Atrial Fibrillation
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So-Ryoung Lee, Young Keun On
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Cardiovasc Prev Pharmacother. 2020;2(1):1-10. Published online January 31, 2020
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DOI: https://doi.org/10.36011/cpp.2020.2.e5
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Abstract
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- Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. In the Asian population, patients with AF have been shown to have increased risks of ischemic stroke and all-cause death compared to patients without AF by 3.34- and 2.61-fold, respectively. AF guidelines recommend oral anticoagulation (OAC) therapy in AF patients with a CHA2DS2-VASc score of ≥1 for men and ≥2 for women with non-valvular AF. After the introduction of non-vitamin K antagonist oral anticoagulants (NOACs) as a treatment for AF, their use has become widespread. Compared to warfarin, NOACs showed comparable efficacy for the prevention of thromboembolic events and superior safety in terms of bleeding complications, especially intracranial hemorrhage. Physicians should keep in mind considerations for optimal OAC therapy to achieve the best outcome. Furthermore, appropriate dose selection in order to achieve the best clinical outcome is an important issue in clinical practice. All NOACs do not have the same rules for dose reduction, and dose reduction of NOACs is primarily recommended according to the dose reduction criteria investigated in pivotal randomized control trials. In this review, we focus on the optimal dose of NOAC and summarize current guidelines and evidence for appropriate dosing of NOACs.
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