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(Circulation. 2005;112:iii.)
© 2005 American Heart Association, Inc.

Viewpoint

Atrial fibrillation - an end to the epidemic?

John Camm, MD

John Camm, MD, Professor of Clinical Cardiology at the Division of Cardiac and Vascular Sciences, St George s Hospital, London, considers the possibility

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Atrial fibrillation (AF) is said to be an epidemic,¹ affecting1% to 1.5% of the population. The arrhythmia presently costs approximately 1% of the health care budget in the United Kingdom and in France. The prevalence is increasing because the population is aging andmanyolderpeoplehavesurvivedpotentialcardiovasculartragedies, leaving them exposed to the more insidious effects of underlying cardiovascular disease. Atrial fibrillation is one result.

Although the arrhythmia carries little direct hazard, the risk of thromboembolism is substantial and increases exponentially with age.² Warfarin, but not aspirin, virtually eliminates this risk but carries its own dangers, predominantly hemorrhage. It is difficult to manage therapy with warfarin: full compliance, routine anticoagulation checks, polypharmacy vigilance, alcohol temperance, a consistent dietary regimen and the good fortune not to be involved in any significant trauma are essential but not guaranteed. Only 60% of those who need this therapy are treated.³

New anticoagulant strategies are necessary and seemed imminent until a direct thrombin inhibitor,⁴ already available in parts of Europe for the reduction of postoperative venous thromboembolism, was refused approval by regulatory authorities for use in atrial fibrillation.

However, almost every big pharmaceutical company is interested in this problem and it will not be long before the thromboembolic risks of AF can be effectively treated without the hazards and inconvenience of warfarin treatment. Antiarrhythmic therapies, particularly amiodarone, sotalol, propafenone and flecainide, are moderately effective at initially reducing the incidence of paroxysms or persistent bouts of AF. Eventually, however, the disease becomes unresponsive, tolerance develops or side effects accumulate. Other therapies . . . [Full Text of this Article]