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CARDIOVASCULAR TEAM APPROACH SERIES ATRIAL FIBRILLATION A MULTIDISCIPLINARY APPROACH TO IMPROVING PATIENT OUTCOMES Volume Editors: N.A. Mar k Es t es III, MD Alber t L. Waldo, MD, PhD (Hon) For eword by A. J ohn Camm, MD Atrial Fibrillation A Multidisciplinary Approach to Improving Patient Outcomes The Cardiovascular Team Approach A book series focusing on the interprofessional team approach for the management and prevention of cardiovascular diseases. Editors-in-Chief: Joseph S. Alpert, MD, FAHA, FACC, MACP, FESC Lynne T. Braun, PhD, CNP, FAHA, FAAN Barbara J. Fletcher, RN, MN, FAHA, FAAN Gerald Fletcher, MD, FAHA, FACC, FACP Look for these and other forthcoming series titles from Cardiotext Publishing. Volume 1 : Heart Failure: Strategies to Improve Outcomes Ileana L. Piña, MD, MPH, FACC, FAHA, and Elizabeth A. Madigan, PhD, RN, FAAN, editors Volume 2 : Prehospital Management of Acute STEMI: Practical Approaches and International Strategies for Early Intervention Edgardo Escobar, MD, FACC, FAHA, and Alejandro Barbagelata, MD, FAHA, FSCAI, editors Volume 3 : Acute Coronary Syndrome: Urgent and Follow-up Care Eileen Handberg, PhD, ARNP, BC, FAHA, FACC, and R. David Anderson, MD, MS, FACC, FSCAI, editors Volume 4 : Atrial Fibrillation: A Multidisciplinary Approach to Improving Patient Outcomes N.A. Mark Estes III, MD, FACC, FHRS, FAHA, FESC, and Albert L. Waldo, MD, PhD (Hon), FACC, FHRS, FAHA, FACCP, editors Please visit www.cardiotextpublishing.com for more information about this series. Atrial Fibrillation A Multidisciplinary Approach to Improving Patient Outcomes The Cardiovascular Team Approach Series VOLUME 4 N.A. Mark Estes III, MD, FACC, FHRS, FAHA, FESC Albert L. Waldo, MD, PhD (Hon), FACC, FHRS, FAHA, FACCP Volume Editors Joseph S. Alpert, MD, FAHA, FACC, MACP, FESC Lynne T. Braun, PHD, CNP, FAHA, FAAN Barbara J. Fletcher, RN, MN, FAHA, FAAN Gerald Fletcher, MD, FAHA, FACC, FACP Editors-in-Chief Minneapolis, Minnesota © 2015 Joseph S. Alpert, Lynne T. Braun, Barbara J. Fletcher, Gerald Fletcher Cardiotext Publishing, LLC 3405 W. 44th Street Minneapolis, Minnesota 55410 USA www.cardiotextpublishing.com Any updates to this book may be found at: www.cardiotextpublishing.com/atrial-fibrillation-a-multidisciplinary-approachto-improving-patient-outcomes Comments, inquiries, and requests for bulk sales can be directed to the publisher at: info@cardiotextpublishing.com. All rights reserved. No part of this book may be reproduced in any form or by any means without the prior permission of the publisher. All trademarks, service marks, and trade names used herein are the property of their respective owners and are used only to identify the products or services of those owners. This book is intended for educational purposes and to further general scientific and medical knowledge, research, and understanding of the conditions and associated treatments discussed herein. This book is not intended to serve as and should not be relied upon as recommending or promoting any specific diagnosis or method of treatment for a particular condition or a particular patient. It is the reader’s responsibility to determine the proper steps for diagnosis and the proper course of treatment for any condition or patient, including suitable and appropriate tests, medications or medical devices to be used for or in conjunction with any diagnosis or treatment. Due to ongoing research, discoveries, modifications to medicines, equipment and devices, and changes in government regulations, the information contained in this book may not reflect the latest standards, developments, guidelines, regulations, products or devices in the field. Readers are responsible for keeping up to date with the latest developments and are urged to review the latest instructions and warnings for any medicine, equipment or medical device. Readers should consult with a specialist or contact the vendor of any medicine or medical device where appropriate. Except for the publisher’s website associated with this work, the publisher is not affiliated with and does not sponsor or endorse any websites, organizations or other sources of information referred to herein. The publisher and the authors specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this book. Unless otherwise stated, all figures and tables in this book are used courtesy of the authors. Library of Congress Control Number: 2015933471 ISBN: 978-1-935395-95-9 Printed in the United States of America To our wives, Noël and Rosin, with great appreciation, admiration, and affection. Your thoughtfulness, patience, and love have made all the difference. —N.A. Mark Estes, III and Albert L. Waldo Contents About the Editors-in-Chief About the Authors Foreword Preface Abbreviations xiii xv xix xxiii xxv Section 1: Atrial Fibrillatio n: Backg ro und, Evaluatio n, and Manag e me nt Chapter 1 Classification and Epidemiology of Atrial Fibrillation Faisal Rahman and Emelia J. Benjamin Introduction Classification Epidemiology Longitudinal History Pathophysiology Conclusions References Chapter 2 Clinical Evaluation of the Atrial Fibrillation Patient Jennifer Cruz and Paul Dorian Introduction A Systematic, Protocol-Based Approach to Patient Evaluation Software Program for Data Collection, Storage, and Decision Aids Decision Making Lifestyle Recommendations Clinical Pearls Conclusion Appendix A: Selected Screenshots from the Data Entry/Management and Decision Aid/Report Generation Software Appendix B: Example of Patient Educational Materials and Relevant Websites References 1 3 3 3 4 8 9 12 12 21 21 21 22 28 31 31 32 33 43 43 vii viii Co nte nts Chapter 3 Rhythm Management: Making the Choice Between Rate and Rhythm Control D. George Wyse and Laurie Burland Introduction Rate Control—What Is It? Rhythm Control—What Is It? Comparison of the Impact of Rate- and Rhythm-Control Strategies on Outcomes Other Than Electrocardiographic Objectives Impact of Catheter Ablation in Comparison of Rhythm-Management Strategies Conclusion Acknowledgment References 47 47 47 48 49 56 56 57 58 Chapter 4 Rhythm Control: Cardioversion and Antiarrhythmic Agents Shameer Ahmed and Gerald V. Naccarelli Introduction Cardioversion Electrical Cardioversion Pharmacological Cardioversion Conclusion References 61 Chapter 5 Strategies of Rate Control Jonathan Weinstock Introduction Pharmacologic Rate Control Rate-Control Goals AF and Ventricular Preexcitation AV Node Ablation and Pacing AF and CRT Conclusion References 79 Chapter 6 Nonpharmacologic Approaches to Rhythm Control—Ablation Michael P. Riley and Andrew E. Epstein Patient Selection Techniques Management of Anticoagulation Outcomes Conclusion References 87 61 61 62 65 74 74 79 79 81 82 83 83 84 85 87 88 91 91 93 94