Atrial fibrillation Wolff-Parkinson-White preexcitation syndromes: Difference between revisions

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{{Atrial fibrillation}}
{{Atrial fibrillation}}


{{CMG}}; '''Associate Editor(s)-In-Chief:''' {{CZ}}; [[Varun Kumar, M.B.B.S.]]
{{CMG}}; '''Associate Editor(s)-In-Chief:''' {{Anahita}} {{CZ}}; [[Varun Kumar, M.B.B.S.]]


==Overview==
==Overview==
The incidence of [[sudden cardiac death]] is between 0% and 0.6% in patients with [[Wolff-Parkinson-White syndrome]],<ref name="pmid8443907">Munger TM, Packer DL, Hammill SC, Feldman BJ, Bailey KR, Ballard DJ et al. (1993) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8443907 A population study of the natural history of Wolff-Parkinson-White syndrome in Olmsted County, Minnesota, 1953-1989.] ''Circulation'' 87 (3):866-73. PMID: [http://pubmed.gov/8443907 8443907]</ref><ref name="pmid2225373">Leitch JW, Klein GJ, Yee R, Murdock C (1990) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2225373 Prognostic value of electrophysiology testing in asymptomatic patients with Wolff-Parkinson-White pattern.] ''Circulation'' 82 (5):1718-23. PMID: [http://pubmed.gov/2225373 2225373]</ref><ref name="pmid2502088">Soria R, Guize L, Chretien JM, Le Heuzey JY, Lavergne T, Desnos M et al. (1989) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2502088 [The natural history of 270 cases of Wolff-Parkinson-White syndrome in a survey of the general population].] ''Arch Mal Coeur Vaiss'' 82 (3):331-6. PMID: [http://pubmed.gov/2502088 2502088]</ref><ref name="pmid5807647">Flensted-Jensen E (1969) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=5807647 Wolff-Parkinson-White syndrome. A long-term follow-up of 47 cases.] ''Acta Med Scand'' 186 (1-2):65-74. PMID: [http://pubmed.gov/5807647 5807647]</ref> particularly those with short antegrade bypass tract refractory periods (less than 250 ms) and short R-R intervals during pre-excited [[AF]] (180 plus or minus 29 ms).<ref name="pmid492252">Klein GJ, Bashore TM, Sellers TD, Pritchett EL, Smith WM, Gallagher JJ (1979) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=492252 Ventricular fibrillation in the Wolff-Parkinson-White syndrome.] ''N Engl J Med'' 301 (20):1080-5. [http://dx.doi.org/10.1056/NEJM197911153012003 DOI:10.1056/NEJM197911153012003] PMID: [http://pubmed.gov/492252 492252]</ref><ref name="pmid7517532">Zardini M, Yee R, Thakur RK, Klein GJ (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7517532 Risk of sudden arrhythmic death in the Wolff-Parkinson-White syndrome: current perspectives.] ''Pacing Clin Electrophysiol'' 17 (5 Pt 1):966-75. PMID: [http://pubmed.gov/7517532 7517532]</ref> In hemodynamically stable patients, intravenous [[procainamide]] may be administered to convert pre-exited [[AF]] to sinus rhythm. AV nodal blocking agents such as [[digoxin]], [[diltiazem]], or [[verapamil]] are contra-indicated as they increase AV-node refractoriness which could encourage preferential conduction over the accessory pathway. [[AF]] associated with a rapid [[tachycardia]] due to an accessory pathway may be treated with [[flecainide]] that has shown to slower the ventricular rate by prolonging the shortest pre-excited cycle length during AF and hence terminate [[AF]].<ref name="pmid4006340">Kappenberger LJ, Fromer MA, Shenasa M, Gloor HO (1985) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=4006340 Evaluation of flecainide acetate in rapid atrial fibrillation complicating Wolff-Parkinson-White syndrome.] ''Clin Cardiol'' 8 (6):321-6. PMID: [http://pubmed.gov/4006340 4006340]</ref><ref name="pmid3136632">Kim SS, Smith P, Ruffy R (1988) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3136632 Treatment of atrial tachyarrhythmias and preexcitation syndrome with flecainide acetate.] ''Am J Cardiol'' 62 (6):29D-34D. PMID: [http://pubmed.gov/3136632 3136632]</ref><ref name="pmid3132032">Crijns HJ, den Heijer P, van Wijk LM, Lie KI (1988) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3132032 Successful use of flecainide in atrial fibrillation with rapid ventricular rate in the Wolff-Parkinson-White syndrome.] ''Am Heart J'' 115 (6):1317-21. PMID: [http://pubmed.gov/3132032 3132032]</ref><ref name="pmid1721219">O'Nunain S, Garratt CJ, Linker NJ, Gill J, Ward DE, Camm AJ (1991) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1721219 A comparison of intravenous propafenone and flecainide in the treatment of tachycardias associated with the Wolff-Parkinson-White syndrome.] ''Pacing Clin Electrophysiol'' 14 (11 Pt 2):2028-34. PMID: [http://pubmed.gov/1721219 1721219]</ref>
In up to one-third of [[patients]] with [[Wolff-Parkinson-White syndrome]], paroxysmal [[atrial fibrillation]] develops. Studies have been demonstrated that [[Wolff-Parkinson-White syndrome]] with a left lateral bypass tract has even a higher [[incidence]] of [[atrial fibrillation]]. On the other hand [[Wolff-Parkinson-White syndrome]] [[patients]] with right free wall accessory pathway have a lower chance of [[atrial fibrillation]] development. Development of [[atrial fibrillation]] in a [[patient]] with [[Wolff-Parkinson-White syndrome]] can result in [[Complication (medicine)|complications]] such as [[syncope]], [[ventricular fibrillation]] and ultimately sudden death. There are some hypothesized mechanisms for development of paroxysmal [[atrial fibrillation]] in [[patients]] with [[Wolff-Parkinson-White syndrome]], such as effects of accessory pathways on [[atrium]], spontaneous deterioration of [[AV reentrant tachycardia]] ([[AV reentrant tachycardia|AVRT]]) into [[atrial fibrillation]] and [[atrium|atrial]] [[Cardiac muscle|muscle]]'s electrical abnormalities. In [[Hemodynamics|hemodynamically]] stable [[patients]], [[Intravenous therapy|intravenous]] [[procainamide]] may be administered to convert pre-exited [[atrial fibrillation]] to [[sinus rhythm]]. [[Atrial fibrillation]] associated with a rapid [[tachycardia]] due to an accessory pathway may be treated with [[flecainide]] that has shown to slower the [[ventricle|ventricular]] rate by prolonging the shortest pre-excited cycle length during [[atrial fibrillation]] and hence terminate [[atrial fibrillation]].


==2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial                     Fibrillation (DO NOT EDIT)<ref name="pmid21392637">{{cite journal| author=Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al.| title=2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. | journal=J Am Coll Cardiol | year= 2011 | volume= 57 | issue= 11 | pages= e101-98 | pmid=21392637 | doi=10.1016/j.jacc.2010.09.013 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21392637  }} </ref>==
==Atrial fibrillation in Wolff-Parkinson-White preexcitation syndromes==
*The [[incidence]] of [[sudden cardiac death]] is between 0% and 0.6% in [[patients]] with [[Wolff-Parkinson-White syndrome]], particularly those with short antegrade bypass tract refractory periods (less than 250 ms) and short [[RR interval|R-R intervals]] during pre-excited [[atrial fibrillation]] (180 plus or minus 29 ms).<ref name="pmid8443907">Munger TM, Packer DL, Hammill SC, Feldman BJ, Bailey KR, Ballard DJ et al. (1993) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8443907 A population study of the natural history of Wolff-Parkinson-White syndrome in Olmsted County, Minnesota, 1953-1989.] ''Circulation'' 87 (3):866-73. PMID: [http://pubmed.gov/8443907 8443907]</ref><ref name="pmid2225373">Leitch JW, Klein GJ, Yee R, Murdock C (1990) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2225373 Prognostic value of electrophysiology testing in asymptomatic patients with Wolff-Parkinson-White pattern.] ''Circulation'' 82 (5):1718-23. PMID: [http://pubmed.gov/2225373 2225373]</ref><ref name="pmid2502088">Soria R, Guize L, Chretien JM, Le Heuzey JY, Lavergne T, Desnos M et al. (1989) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2502088 [The natural history of 270 cases of Wolff-Parkinson-White syndrome in a survey of the general population].] ''Arch Mal Coeur Vaiss'' 82 (3):331-6. PMID: [http://pubmed.gov/2502088 2502088]</ref><ref name="pmid5807647">Flensted-Jensen E (1969) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=5807647 Wolff-Parkinson-White syndrome. A long-term follow-up of 47 cases.] ''Acta Med Scand'' 186 (1-2):65-74. PMID: [http://pubmed.gov/5807647 5807647]</ref><ref name="pmid492252">Klein GJ, Bashore TM, Sellers TD, Pritchett EL, Smith WM, Gallagher JJ (1979) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=492252 Ventricular fibrillation in the Wolff-Parkinson-White syndrome.] ''N Engl J Med'' 301 (20):1080-5. [http://dx.doi.org/10.1056/NEJM197911153012003 DOI:10.1056/NEJM197911153012003] PMID: [http://pubmed.gov/492252 492252]</ref><ref name="pmid7517532">Zardini M, Yee R, Thakur RK, Klein GJ (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7517532 Risk of sudden arrhythmic death in the Wolff-Parkinson-White syndrome: current perspectives.] ''Pacing Clin Electrophysiol'' 17 (5 Pt 1):966-75. PMID: [http://pubmed.gov/7517532 7517532]</ref>
*In up to one-third of [[patients]] with [[Wolff-Parkinson-White syndrome]], paroxysmal [[atrial fibrillation]] develops, nevertheless the mechanism for this elevated [[incidence]] is not completely understood.<ref name="pmid18308751">{{cite journal| author=Centurión OA, Shimizu A, Isomoto S, Konoe A| title=Mechanisms for the genesis of paroxysmal atrial fibrillation in the Wolff Parkinson-White syndrome: intrinsic atrial muscle vulnerability vs. electrophysiological properties of the accessory pathway. | journal=Europace | year= 2008 | volume= 10 | issue= 3 | pages= 294-302 | pmid=18308751 | doi=10.1093/europace/eun031 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18308751  }} </ref> 
*Studies have been demonstrated that [[Wolff-Parkinson-White syndrome]] with a left lateral bypass tract has even a higher [[incidence]] of double [[atrium|atrial]] potentials and induced [[atrial fibrillation]]. On the other hand [[Wolff-Parkinson-White syndrome]] [[patients]] with right free wall accessory pathway have a lower chance of [[atrial fibrillation]] development.<ref name="pmid15383772">{{cite journal| author=Hsieh MH, Tai CT, Chiang CE, Tsai CF, Chen YJ, Chan P | display-authors=etal| title=Double atrial potentials recorded in the coronary sinus in patients with Wolff-Parkinson-White syndrome: a possible mechanism of induced atrial fibrillation. | journal=J Interv Card Electrophysiol | year= 2004 | volume= 11 | issue= 2 | pages= 97-103 | pmid=15383772 | doi=10.1023/B:JICE.0000042347.27095.b4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15383772  }} </ref><ref name="pmid2016453">{{cite journal| author=Della Bella P, Brugada P, Talajic M, Lemery R, Torner P, Lezaun R | display-authors=etal| title=Atrial fibrillation in patients with an accessory pathway: importance of the conduction properties of the accessory pathway. | journal=J Am Coll Cardiol | year= 1991 | volume= 17 | issue= 6 | pages= 1352-6 | pmid=2016453 | doi=10.1016/s0735-1097(10)80146-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2016453  }} </ref>
*Development of [[atrial fibrillation]] in a [[patient]] with [[Wolff-Parkinson-White syndrome]] can result in [[Complication (medicine)|complications]] such as [[syncope]], [[ventricular fibrillation]] and ultimately sudden death.<ref name="pmid1509997">{{cite journal| author=Pietersen AH, Andersen ED, Sandøe E| title=Atrial fibrillation in the Wolff-Parkinson-White syndrome. | journal=Am J Cardiol | year= 1992 | volume= 70 | issue= 5 | pages= 38A-43A | pmid=1509997 | doi=10.1016/0002-9149(92)91076-g | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1509997  }} </ref>
*The following are some of the hypothesized mechanisms for development of paroxysmal [[atrial fibrillation]] in [[patients]] with [[Wolff-Parkinson-White syndrome]]:<ref name="pmid18308751">{{cite journal| author=Centurión OA, Shimizu A, Isomoto S, Konoe A| title=Mechanisms for the genesis of paroxysmal atrial fibrillation in the Wolff Parkinson-White syndrome: intrinsic atrial muscle vulnerability vs. electrophysiological properties of the accessory pathway. | journal=Europace | year= 2008 | volume= 10 | issue= 3 | pages= 294-302 | pmid=18308751 | doi=10.1093/europace/eun031 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18308751  }} </ref><ref name="pmid1378596">{{cite journal| author=Konoe A, Fukatani M, Tanigawa M, Isomoto S, Kadena M, Sakamoto T | display-authors=etal| title=Electrophysiological abnormalities of the atrial muscle in patients with manifest Wolff-Parkinson-White syndrome associated with paroxysmal atrial fibrillation. | journal=Pacing Clin Electrophysiol | year= 1992 | volume= 15 | issue= 7 | pages= 1040-52 | pmid=1378596 | doi=10.1111/j.1540-8159.1992.tb03098.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1378596  }} </ref><ref name="pmid16697118">{{cite journal| author=Zhang Y, Wang L| title=Atrial vulnerability is a major mechanism of paroxysmal atrial fibrillation in patients with Wolff-Parkinson-White syndrome. | journal=Med Hypotheses | year= 2006 | volume= 67 | issue= 6 | pages= 1345-7 | pmid=16697118 | doi=10.1016/j.mehy.2006.02.053 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16697118  }} </ref>
**Spontaneous deterioration of [[AV reentrant tachycardia]] ([[AV reentrant tachycardia|AVRT]]) into [[atrial fibrillation]]
**Effects of accessory pathways on [[atrium]]
***Numerous studies have been reported a decreased [[incidence]] of [[atrial fibrillation]] in [[patients]] who undergone a successful ablation of accessory pathways.
**Possible [[atrium|atrial]] [[Cardiac muscle|muscle]]'s electrical abnormalities and increased [[atrium|atrial]] vulnerability (which is independent of the role that accessory pathways play)
***Since a fraction of [[patients]] experience [[atrial fibrillation]] even after a successful accessory pathway [[ablation]], it can be concluded that there are other mechanisms independent of accessory pathways that cause [[atrial fibrillation]] in [[Wolff-Parkinson-White syndrome]].
***More evaluation with [[atrium|atrial]] [[Endocardium|endocardial]] mapping demonstrated the possibility of [[atrium|atrial]] [[diseases]] (such as intrinsic [[atrium|atrial]] [[muscle]] abnormalities) in [[patients]] with [[Wolff-Parkinson-White syndrome]]. 
*Based on a study done on [[patients]] with [[Wolff-Parkinson-White syndrome]] with documented or induced [[atrial fibrillation]], effective refractory period of the accessory pathway was correlated with the shortest [[RR interval]] and [[ventricle|ventricular]] rate average.
*In [[Hemodynamics|hemodynamically]] stable [[patients]], [[Intravenous therapy|intravenous]] [[procainamide]] may be administered to convert pre-exited [[atrial fibrillation]] to [[sinus rhythm]].<ref name="pmid2229793">{{cite journal| author=Boahene KA, Klein GJ, Yee R, Sharma AD, Fujimura O| title=Termination of acute atrial fibrillation in the Wolff-Parkinson-White syndrome by procainamide and propafenone: importance of atrial fibrillatory cycle length. | journal=J Am Coll Cardiol | year= 1990 | volume= 16 | issue= 6 | pages= 1408-14 | pmid=2229793 | doi=10.1016/0735-1097(90)90384-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2229793  }} </ref>
*[[Atrioventricular node|AV nodal]] blocking agents such as [[digoxin]], [[diltiazem]], or [[verapamil]] are [[contraindication|contra-indicated]] as they increase [[Atrioventricular node|AV-node]] refractoriness which could encourage preferential conduction over the accessory pathway.<ref name="pmid3970402">{{cite journal| author=Jacob AS, Nielsen DH, Gianelly RE| title=Fatal ventricular fibrillation following verapamil in Wolff-Parkinson-White syndrome with atrial fibrillation. | journal=Ann Emerg Med | year= 1985 | volume= 14 | issue= 2 | pages= 159-60 | pmid=3970402 | doi=10.1016/s0196-0644(85)81080-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3970402  }} </ref>
*[[Atrial fibrillation]] associated with a rapid [[tachycardia]] due to an accessory pathway may be treated with [[flecainide]] that has shown to slower the [[ventricle|ventricular]] rate by prolonging the shortest pre-excited cycle length during [[atrial fibrillation]] and hence terminate [[atrial fibrillation]].<ref name="pmid4006340">Kappenberger LJ, Fromer MA, Shenasa M, Gloor HO (1985) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=4006340 Evaluation of flecainide acetate in rapid atrial fibrillation complicating Wolff-Parkinson-White syndrome.] ''Clin Cardiol'' 8 (6):321-6. PMID: [http://pubmed.gov/4006340 4006340]</ref><ref name="pmid3136632">Kim SS, Smith P, Ruffy R (1988) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3136632 Treatment of atrial tachyarrhythmias and preexcitation syndrome with flecainide acetate.] ''Am J Cardiol'' 62 (6):29D-34D. PMID: [http://pubmed.gov/3136632 3136632]</ref><ref name="pmid3132032">Crijns HJ, den Heijer P, van Wijk LM, Lie KI (1988) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3132032 Successful use of flecainide in atrial fibrillation with rapid ventricular rate in the Wolff-Parkinson-White syndrome.] ''Am Heart J'' 115 (6):1317-21. PMID: [http://pubmed.gov/3132032 3132032]</ref><ref name="pmid1721219">O'Nunain S, Garratt CJ, Linker NJ, Gill J, Ward DE, Camm AJ (1991) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1721219 A comparison of intravenous propafenone and flecainide in the treatment of tachycardias associated with the Wolff-Parkinson-White syndrome.] ''Pacing Clin Electrophysiol'' 14 (11 Pt 2):2028-34. PMID: [http://pubmed.gov/1721219 1721219]</ref>
 
==2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)<ref name="JanuaryWann2014">{{cite journal|last1=January|first1=C. T.|last2=Wann|first2=L. S.|last3=Alpert|first3=J. S.|last4=Calkins|first4=H.|last5=Cleveland|first5=J. C.|last6=Cigarroa|first6=J. E.|last7=Conti|first7=J. B.|last8=Ellinor|first8=P. T.|last9=Ezekowitz|first9=M. D.|last10=Field|first10=M. E.|last11=Murray|first11=K. T.|last12=Sacco|first12=R. L.|last13=Stevenson|first13=W. G.|last14=Tchou|first14=P. J.|last15=Tracy|first15=C. M.|last16=Yancy|first16=C. W.|title=2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society|journal=Circulation|year=2014|issn=0009-7322|doi=10.1161/CIR.0000000000000041}}</ref>==
====Wolff-Parkinson-White and Pre-Excitation Syndromes====
 
{|class="wikitable" style="width: 80%;"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Prompt direct-current [[cardioversion]] is recommended for [[patients]] with [[atrial fibrillation]], [[Wolff-Parkinson-White syndrome]] ([[Wolff-Parkinson-White syndrome|WPW]]), and rapid [[venticle|ventricular]] response who are [[hemodynamic|hemodynamically]] compromised. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' [[Intravenous]] [[procainamide]] or [[ibutilide]] to restore [[sinus rhythm]] or slow the [[ventricle|ventricular]] rate is recommended for [[patients]] with [[pre-excitation|pre-excited]] [[atrial fibrillation]] and rapid [[ventricle|ventricular]] response who are not [[hemodynamic|hemodynamically]] compromised. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' [[Catheter ablation]] of the [[accessory pathway]] is recommended in [[symptom|symptomatic]] [[patients]] with [[pre-excitation|pre-excited]] [[atrial fibrillation]], especially if the accessory pathway has a short refractory period that allows rapid antegrade conduction. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
 
{|class="wikitable" style="width: 80%;"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III: No Benefit]]
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.'''  Administration of [[intravenous]] [[amiodarone]], [[adenosine]], [[digoxin]] ([[mouth|oral]] or [[intravenous]]), or [[Calcium channel blocker#Non-dihydropyridine|nondihydropyridine calcium antagonists]] ([[mouth|oral]] or [[intravenous]]) in [[patients]] with [[Wolff-Parkinson-White syndrome]] ([[Wolff-Parkinson-White syndrome|WPW]]) who have [[pre-excitation|pre-excited]] [[atrial fibrillation]] is potentially harmful as these [[treatments]] accelerate the [[ventricle|ventricular]] rate. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}
 
==2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)<ref name="pmid21392637">{{cite journal| author=Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al.| title=2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. | journal=J Am Coll Cardiol | year= 2011 | volume= 57 | issue= 11 | pages= e101-98 | pmid=21392637 | doi=10.1016/j.jacc.2010.09.013 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21392637  }} </ref>==
===Wolff-Parkinson-White (WPW) Preexcitation Syndromes (DO NOT EDIT) <ref name="pmid21392637">{{cite journal| author=Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al.| title=2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. | journal=J Am Coll Cardiol | year= 2011 | volume= 57 | issue= 11 | pages= e101-98 | pmid=21392637 | doi=10.1016/j.jacc.2010.09.013 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21392637  }} </ref>===
===Wolff-Parkinson-White (WPW) Preexcitation Syndromes (DO NOT EDIT) <ref name="pmid21392637">{{cite journal| author=Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al.| title=2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. | journal=J Am Coll Cardiol | year= 2011 | volume= 57 | issue= 11 | pages= e101-98 | pmid=21392637 | doi=10.1016/j.jacc.2010.09.013 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21392637  }} </ref>===


Line 28: Line 66:
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[Catheter ablation]] of the accessory pathway is recommended in symptomatic patients with [[AF]] who have [[WPW syndrome]], particularly those with [[syncope]] due to rapid heart rate or those with a short bypass tract refractory period. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[Catheter ablation]] of the accessory pathway is recommended in [[symptom|symptomatic]] [[patients]] with [[atrial fibrillation]] who have [[Wolff-Parkinson-White syndrome]] ([[Wolff-Parkinson-White syndrome|WPW]]), particularly those with [[syncope]] due to rapid [[heart rate]] or those with a short bypass tract refractory period. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Immediate [[direct-current cardioversion]] is recommended to prevent [[ventricular fibrillation]] in patients with a short anterograde bypass tract refractory period in whom [[AF]] occurs with a rapid ventricular response associated with hemodynamic instability. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Immediate [[direct-current cardioversion]] is recommended to prevent [[ventricular fibrillation]] in [[patients]] with a short anterograde bypass tract refractory period in whom [[atrial fibrillation]] occurs with a rapid [[ventricle|ventricular]] response associated with [[Hemodynamics|hemodynamic]] instability. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Intravenous [[procainamide]] or [[ibutilide]] is recommended to restore [[sinus rhythm]] in patients with [[WPW syndrome]] in whom [[AF]] occurs without hemodynamic instability in association with a wide [[QRS complex]] on the [[ECG]] (greater than or equal to 120-ms duration) or with a rapid pre-excited ventricular response. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' [[Intravenous therapy|Intravenous]] [[procainamide]] or [[ibutilide]] is recommended to restore [[sinus rhythm]] in [[patients]] with [[Wolff-Parkinson-White syndrome]] ([[Wolff-Parkinson-White syndrome|WPW]]) in whom [[atrial fibrillation]] occurs without [[Hemodynamics|hemodynamic]] instability in association with a wide [[QRS complex]] on the [[The electrocardiogram|ECG]] (greater than or equal to 120-ms duration) or with a rapid pre-excited [[ventricle|ventricular]] response. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
|}


Line 39: Line 77:
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
|-
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Intravenous administration of digitalis glycosides or nondihydropyridine calcium channel antagonists is not recommended in patients with WPW syndrome who have preexcited ventricular activation during AF. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' [[Intravenous therapy|Intravenous]] administration of [[Digoxin|digitalis glycosides]] or [[Calcium channel blocker|nondihydropyridine calcium channel antagonists]] is not recommended in [[patients]] with [[Wolff-Parkinson-White syndrome]] ([[Wolff-Parkinson-White syndrome|WPW]]) who have preexcited [[ventricle|ventricular]] activation during [[atrial fibrillation]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}
|}


Line 46: Line 84:
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Intravenous [[flecainide]] or [[direct-current cardioversion]] is reasonable when very rapid ventricular rates occur in patients with [[AF]] involving conduction over an accessory pathway. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' [[Intravenous therapy|Intravenous]] [[flecainide]] or [[direct-current cardioversion]] is reasonable when very rapid [[ventricle|ventricular]] rates occur in [[patients]] with [[atrial fibrillation]] involving conduction over an accessory pathway. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}
|}


Line 53: Line 91:
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' It may be reasonable to administer intravenous [[quinidine]], [[procainamide]], [[disopyramide]], [[ibutilide]], or [[amiodarone]] to hemodynamically stable patients with [[AF]] involving conduction over an accessory pathway. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' It may be reasonable to administer [[Intravenous therapy|intravenous]] [[quinidine]], [[procainamide]], [[disopyramide]], [[ibutilide]], or [[amiodarone]] to [[Hemodynamics|hemodynamically]] stable [[patients]] with [[atrial fibrillation]] involving conduction over an accessory pathway. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}
|}


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==References==
==References==
{{reflist|2}}
{{reflist|2}}
[[CME Category::Cardiology]]


[[Category:Electrophysiology]]
[[Category:Electrophysiology]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]

Latest revision as of 03:05, 6 September 2021
Resident
Survival
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Sinus rhythm
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Atrial Fibrillation Microchapters

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Atrial fibrillation Wolff-Parkinson-White preexcitation syndromes On the Web

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Anahita Deylamsalehi, M.D.[2] Cafer Zorkun, M.D., Ph.D. [3]; Varun Kumar, M.B.B.S.

Overview

In up to one-third of patients with Wolff-Parkinson-White syndrome, paroxysmal atrial fibrillation develops. Studies have been demonstrated that Wolff-Parkinson-White syndrome with a left lateral bypass tract has even a higher incidence of atrial fibrillation. On the other hand Wolff-Parkinson-White syndrome patients with right free wall accessory pathway have a lower chance of atrial fibrillation development. Development of atrial fibrillation in a patient with Wolff-Parkinson-White syndrome can result in complications such as syncope, ventricular fibrillation and ultimately sudden death. There are some hypothesized mechanisms for development of paroxysmal atrial fibrillation in patients with Wolff-Parkinson-White syndrome, such as effects of accessory pathways on atrium, spontaneous deterioration of AV reentrant tachycardia (AVRT) into atrial fibrillation and atrial muscle's electrical abnormalities. In hemodynamically stable patients, intravenous procainamide may be administered to convert pre-exited atrial fibrillation to sinus rhythm. Atrial fibrillation associated with a rapid tachycardia due to an accessory pathway may be treated with flecainide that has shown to slower the ventricular rate by prolonging the shortest pre-excited cycle length during atrial fibrillation and hence terminate atrial fibrillation.

Atrial fibrillation in Wolff-Parkinson-White preexcitation syndromes

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)[19]

Wolff-Parkinson-White and Pre-Excitation Syndromes

Class I
"1. Prompt direct-current cardioversion is recommended for patients with atrial fibrillation, Wolff-Parkinson-White syndrome (WPW), and rapid ventricular response who are hemodynamically compromised. (Level of Evidence: C)"
"2. Intravenous procainamide or ibutilide to restore sinus rhythm or slow the ventricular rate is recommended for patients with pre-excited atrial fibrillation and rapid ventricular response who are not hemodynamically compromised. (Level of Evidence: C)"
"3. Catheter ablation of the accessory pathway is recommended in symptomatic patients with pre-excited atrial fibrillation, especially if the accessory pathway has a short refractory period that allows rapid antegrade conduction. (Level of Evidence: C)"
Class III: No Benefit
"1. Administration of intravenous amiodarone, adenosine, digoxin (oral or intravenous), or nondihydropyridine calcium antagonists (oral or intravenous) in patients with Wolff-Parkinson-White syndrome (WPW) who have pre-excited atrial fibrillation is potentially harmful as these treatments accelerate the ventricular rate. (Level of Evidence: B)"

2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)[20]

Wolff-Parkinson-White (WPW) Preexcitation Syndromes (DO NOT EDIT) [20]

Class I
"1. Catheter ablation of the accessory pathway is recommended in symptomatic patients with atrial fibrillation who have Wolff-Parkinson-White syndrome (WPW), particularly those with syncope due to rapid heart rate or those with a short bypass tract refractory period. (Level of Evidence: B)"
"2. Immediate direct-current cardioversion is recommended to prevent ventricular fibrillation in patients with a short anterograde bypass tract refractory period in whom atrial fibrillation occurs with a rapid ventricular response associated with hemodynamic instability. (Level of Evidence: B)"
"3. Intravenous procainamide or ibutilide is recommended to restore sinus rhythm in patients with Wolff-Parkinson-White syndrome (WPW) in whom atrial fibrillation occurs without hemodynamic instability in association with a wide QRS complex on the ECG (greater than or equal to 120-ms duration) or with a rapid pre-excited ventricular response. (Level of Evidence: C)"
Class III (Harm)
"1. Intravenous administration of digitalis glycosides or nondihydropyridine calcium channel antagonists is not recommended in patients with Wolff-Parkinson-White syndrome (WPW) who have preexcited ventricular activation during atrial fibrillation. (Level of Evidence: B)"
Class IIa
"1. Intravenous flecainide or direct-current cardioversion is reasonable when very rapid ventricular rates occur in patients with atrial fibrillation involving conduction over an accessory pathway. (Level of Evidence: B)"
Class IIb
"1. It may be reasonable to administer intravenous quinidine, procainamide, disopyramide, ibutilide, or amiodarone to hemodynamically stable patients with atrial fibrillation involving conduction over an accessory pathway. (Level of Evidence: B)"

Sources

References

  1. ↑ Munger TM, Packer DL, Hammill SC, Feldman BJ, Bailey KR, Ballard DJ et al. (1993) A population study of the natural history of Wolff-Parkinson-White syndrome in Olmsted County, Minnesota, 1953-1989. Circulation 87 (3):866-73. PMID: 8443907
  2. ↑ Leitch JW, Klein GJ, Yee R, Murdock C (1990) Prognostic value of electrophysiology testing in asymptomatic patients with Wolff-Parkinson-White pattern. Circulation 82 (5):1718-23. PMID: 2225373
  3. ↑ Soria R, Guize L, Chretien JM, Le Heuzey JY, Lavergne T, Desnos M et al. (1989) [The natural history of 270 cases of Wolff-Parkinson-White syndrome in a survey of the general population.] Arch Mal Coeur Vaiss 82 (3):331-6. PMID: 2502088
  4. ↑ Flensted-Jensen E (1969) Wolff-Parkinson-White syndrome. A long-term follow-up of 47 cases. Acta Med Scand 186 (1-2):65-74. PMID: 5807647
  5. ↑ Klein GJ, Bashore TM, Sellers TD, Pritchett EL, Smith WM, Gallagher JJ (1979) Ventricular fibrillation in the Wolff-Parkinson-White syndrome. N Engl J Med 301 (20):1080-5. DOI:10.1056/NEJM197911153012003 PMID: 492252
  6. ↑ Zardini M, Yee R, Thakur RK, Klein GJ (1994) Risk of sudden arrhythmic death in the Wolff-Parkinson-White syndrome: current perspectives. Pacing Clin Electrophysiol 17 (5 Pt 1):966-75. PMID: 7517532
  7. ↑ 7.0 7.1 Centurión OA, Shimizu A, Isomoto S, Konoe A (2008). "Mechanisms for the genesis of paroxysmal atrial fibrillation in the Wolff Parkinson-White syndrome: intrinsic atrial muscle vulnerability vs. electrophysiological properties of the accessory pathway". Europace. 10 (3): 294–302. doi:10.1093/europace/eun031. PMID 18308751.
  8. ↑ Hsieh MH, Tai CT, Chiang CE, Tsai CF, Chen YJ, Chan P; et al. (2004). "Double atrial potentials recorded in the coronary sinus in patients with Wolff-Parkinson-White syndrome: a possible mechanism of induced atrial fibrillation". J Interv Card Electrophysiol. 11 (2): 97–103. doi:10.1023/B:JICE.0000042347.27095.b4. PMID 15383772.
  9. ↑ Della Bella P, Brugada P, Talajic M, Lemery R, Torner P, Lezaun R; et al. (1991). "Atrial fibrillation in patients with an accessory pathway: importance of the conduction properties of the accessory pathway". J Am Coll Cardiol. 17 (6): 1352–6. doi:10.1016/s0735-1097(10)80146-9. PMID 2016453.
  10. ↑ Pietersen AH, Andersen ED, Sandøe E (1992). "Atrial fibrillation in the Wolff-Parkinson-White syndrome". Am J Cardiol. 70 (5): 38A–43A. doi:10.1016/0002-9149(92)91076-g. PMID 1509997.
  11. ↑ Konoe A, Fukatani M, Tanigawa M, Isomoto S, Kadena M, Sakamoto T; et al. (1992). "Electrophysiological abnormalities of the atrial muscle in patients with manifest Wolff-Parkinson-White syndrome associated with paroxysmal atrial fibrillation". Pacing Clin Electrophysiol. 15 (7): 1040–52. doi:10.1111/j.1540-8159.1992.tb03098.x. PMID 1378596.
  12. ↑ Zhang Y, Wang L (2006). "Atrial vulnerability is a major mechanism of paroxysmal atrial fibrillation in patients with Wolff-Parkinson-White syndrome". Med Hypotheses. 67 (6): 1345–7. doi:10.1016/j.mehy.2006.02.053. PMID 16697118.
  13. ↑ Boahene KA, Klein GJ, Yee R, Sharma AD, Fujimura O (1990). "Termination of acute atrial fibrillation in the Wolff-Parkinson-White syndrome by procainamide and propafenone: importance of atrial fibrillatory cycle length". J Am Coll Cardiol. 16 (6): 1408–14. doi:10.1016/0735-1097(90)90384-2. PMID 2229793.
  14. ↑ Jacob AS, Nielsen DH, Gianelly RE (1985). "Fatal ventricular fibrillation following verapamil in Wolff-Parkinson-White syndrome with atrial fibrillation". Ann Emerg Med. 14 (2): 159–60. doi:10.1016/s0196-0644(85)81080-5. PMID 3970402.
  15. ↑ Kappenberger LJ, Fromer MA, Shenasa M, Gloor HO (1985) Evaluation of flecainide acetate in rapid atrial fibrillation complicating Wolff-Parkinson-White syndrome. Clin Cardiol 8 (6):321-6. PMID: 4006340
  16. ↑ Kim SS, Smith P, Ruffy R (1988) Treatment of atrial tachyarrhythmias and preexcitation syndrome with flecainide acetate. Am J Cardiol 62 (6):29D-34D. PMID: 3136632
  17. ↑ Crijns HJ, den Heijer P, van Wijk LM, Lie KI (1988) Successful use of flecainide in atrial fibrillation with rapid ventricular rate in the Wolff-Parkinson-White syndrome. Am Heart J 115 (6):1317-21. PMID: 3132032
  18. ↑ O'Nunain S, Garratt CJ, Linker NJ, Gill J, Ward DE, Camm AJ (1991) A comparison of intravenous propafenone and flecainide in the treatment of tachycardias associated with the Wolff-Parkinson-White syndrome. Pacing Clin Electrophysiol 14 (11 Pt 2):2028-34. PMID: 1721219
  19. ↑ January, C. T.; Wann, L. S.; Alpert, J. S.; Calkins, H.; Cleveland, J. C.; Cigarroa, J. E.; Conti, J. B.; Ellinor, P. T.; Ezekowitz, M. D.; Field, M. E.; Murray, K. T.; Sacco, R. L.; Stevenson, W. G.; Tchou, P. J.; Tracy, C. M.; Yancy, C. W. (2014). "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society". Circulation. doi:10.1161/CIR.0000000000000041. ISSN 0009-7322.
  20. ↑ 20.0 20.1 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA; et al. (2011). "2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". J Am Coll Cardiol. 57 (11): e101–98. doi:10.1016/j.jacc.2010.09.013. PMID 21392637.
  21. ↑ Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114 (7):e257-354. DOI:10.1161/CIRCULATIONAHA.106.177292 PMID: 16908781
  22. ↑ Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 123 (10):e269-367. DOI:10.1161/CIR.0b013e318214876d PMID: 21382897
  23. ↑ Estes NA, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS et al. (2008) ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation): developed in collaboration with the Heart Rhythm Society. Circulation 117 (8):1101-20. DOI:10.1161/CIRCULATIONAHA.107.187192 PMID: 18283199

CME Category::Cardiology

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