Preface

Atrial fibrillation (AF) continues to remain a challenge to both clinical cardiologists and electrophysiology specialists alike. It is the most common type of arrhythmia in Europe and the United States. Advances in the 21st century have brought about new treatment and diagnostic tools that have provided solutions and explanations for numerous problems plaguing early AF management. However, although the optimal management of this highly prevalent arrhythmia has greatly advanced, many challenges are still notable in the wide spectrum of the disease.

Numerous populations encounter atrial fibrillation in their daily lives, with both the elderly and the pediatric population having their own obstacles for optimal management of this arrhythmia. Apart from traditional echocardiographic methods of identifying patients at risk for persistent AF, there are now new methods for traditional cardiac ultrasonography as well as newer modalities that will enable better prognostication and identification of subtypes that will benefit from various AF treatment strategies. Furthermore, with the advent of newer anti-arrhythmic medications and methods of ablation and stroke prevention, the goals of AF treatment have now become easier to achieve—but not without their own share of side effects and adverse events.

The book is divided into two self-contained and distinct parts: the first on the epidemiology of AF and the second on the treatment of this disease. The chapters are well structured, following a logical description, from the epidemiology of the disease, as mentioned before, and continuing with different options of treatment: anticoagulants, antiarrhythmic drugs, catheter ablation, and surgery. The technical information is accompanied by figures or explanatory tables that summarize the information from the text.

Dr. Mitchell Andrew together with his team from Jersey opens the book with a chapter on the prevalence of AF and use of digital technologies to assess the real burden of the disease. Alive Cor, Omron HeartScan, Zio Patch, RhythmPad, InstantChek, and Zenocire EKG are some of the devices used to detect AF, increasing the value of classical methods used for AF detection. These devices will help us see the true face of this widespread arrhythmia in the general population. After the epidemiology of AF is presented, anticoagulation is discussed in the following two chapters: for both the general population and the elderly. Jo Ann LeQuang and her coauthors first define valvular and non-valvular AF using excellent tables that gather information from different European, American, Canadian, Australian, and New Zealand guidelines as well as studies published by experts in the field. After presenting the thromboembolic and bleeding scores, the authors of the chapter describe both antivitamin K and non-antivitamin K anticoagulants. The new oral anticoagulants are presented extensively, using studies on the safety and efficacy of drugs compared to classical antivitamin K. Finally, the authors offer an approach to choose between different anticoagulants based on clinical and lab data. In the following chapter, Petidier Roberto, together with his coauthors from Madrid, Spain, addresses the problems of anticoagulation in a particular category of patients, namely elderly, frail patients. Polymedicines,

interactions of different drugs with oral anticoagulants, cognitive and nutritional status, low mobilization due to osteoarticular diseases, swallowing and other digestive problems, cancer, renal failure, and the history of bleeding are delineated by the authors as they are the problems of the third age. All these issues make anticoagulant treatment in the elderly a real challenge, which must be resolved patiently to prevent bleeding or thromboembolic events.

In the fourth chapter, on antiarrhythmic therapy, Simovic Stefan and his coauthors from Serbia describe two approaches for AF: rhythm control and rate control. They then outline each class of antiarrhythmic drug, starting with class I: flecainide and propafenone, class II: betablockers, class III: sotalol, dofetilide, amiodarone, and dronedarone; and ending with new classes of antiarrhythmic drugs, namely vernakalant. The authors also show in a table doses of the drugs, indications, side effects, and mechanisms of action.

In the fifth chapter, Szegedi Nándor with his coauthors from Budapest, Hungary, present the catheter ablation technique for the cure of AF. They start with pulmonary vein isolation for paroxysmal AF, and the techniques that are used today: cryoablation and radiofrequency application with the latest technology available—ablation catheters with pressure sensors and the ablation index to avoid overheating and perforation of the left atrial wall. For persistent AF, the authors present the substrate modification approach associated with pulmonary vein isolation.

In the last chapter, Ohri Sunil and his coauthors from Southampton present the surgical treatment of AF. The authors start with a history of the surgical treatment: left atrial isolation, corridor operation, and atrial transection, techniques that had low success rates and were subsequently replaced by MAZE I, MAZE II, MAZE III, and MAZE IV procedures. Furthermore, they describe other energy sources besides the "cut and sew" technique, such as cryoablation and radiofrequency ablation, microwave, laser, and ultrasound. At the end of their chapter they present evidence from the medical literature on the success rate and safety of the surgical procedures as well as studies comparing the surgical approach with the catheter ablation approach.

On behalf of all authors of this book, we hope that this will serve as a guide to the current body of knowledge on the epidemiology, diagnosis, and treatment of this common arrhythmia and, perhaps, in turn inspire young cardiologists to pursue ambitious careers in electrophysiology.

> **Dr. Gabriel Cismaru**  EP lab of the Rehabilitation Hospital Cluj-Napoca, Romania

> > **Dr. Keith Andrew Chan**

**1**

Section 1

Epidemiology of Atrial

Fibrillation

Chief Adult Cardiology Fellow, Chong Hua Hospital, Cebu City, Philippines

### Section 1
