Atrial Fibrillation: Past, Present and Future
Keywords:
atrial fibrillation, cardioembolic cerebrovascular events, direct-action oral anticoagulants, electrocardiogram.Abstract
Of the clinically relevant cardiac arrhythmias, atrial fibrillation is the commonest one and a leading cause of cardiovascular morbidity and mortality, including cerebrovascular events, cardiac insufficiency and sudden death. Its overall prevalence varies from 2 to 5% in patients over 60 years of age and increases up to 10% in those over 80 years of age. A literature review was conducted, with the aim of describing the diagnosis and management of atrial fibrillation in the past, present and future. The therapeutic approach has been focused on anticoagulant drugs for the prevention of cardioembolic events and for antiarrhythmic management. For a long time, the most widely used drug was warfarin, but it has been progressively displaced by direct oral anticoagulants, which have been shown to be more effective and safer. In the antiarrhythmic strategy, there are two paths: cardiac frequency control with drugs such as digoxin (a major protagonist in the past), beta-blockers in the present, calcium antagonists, amiodarone, among others; or the strategy of pharmacological or electrical cardioversion, a definitive management with pulmonary vein isolation. Epipharmaceuticals will be a viable alternative for managing atrial fibrillation. Implantable subdermal devices are envisioned to emerge; they would release the anticoagulant drug in a continuous and controlled manner, as it occurs with similar devices used in other therapeutic schemes, such as subdermal contraceptives, rivastigmine patches, nitroglycerin or analgesics. Therein lies the future of anticoagulation therapy for preventing thromboembolic events and decreasing the consequences of atrial fibrillation.
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