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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n\u003Cp id=\u0022p-1\u0022\u003EAtrial fibrillation (AF) is the most common arrhythmia, yet its etiology is still not completely understood. It is becoming clear, however, that the mechanisms involved in recent onset AF may not be identical to those occurring later in the course of AF. Thus patients\u0027 treatment needs vary.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n\u003Ch2 class=\u0022\u0022\u003ECurrent Recommendations and Emerging Topics in Atrial Fibrillations\u003C\/h2\u003E\n\u003Cp id=\u0022p-2\u0022\u003EAtrial fibrillation (AF) is the most common arrhythmia, yet its etiology is still not completely understood. It is becoming clear, however, that the mechanisms involved in recent onset AF may not be identical to those occurring later in the course of AF. Thus patients\u0027 treatment needs vary. Current recommendations and emerging treatments for AF were the subjects of a number of ACC presentations.\u003C\/p\u003E\n\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/1\/25\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1808999836\u0022 data-figure-caption=\u0022\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure1\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/1\/25\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/1\/25\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure1\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/1\/25\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/10996\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n\u003Ch2 class=\u0022\u0022\u003EEmerging Mechanistic Models\u003C\/h2\u003E\n\u003Cp id=\u0022p-3\u0022\u003EMiguel Valderrabano, MD, of the Methodist DeBakey Heart Center, Houston, Texas, noted that the issue of reentry is still controversial, that fibrillatory conduction is anatomically determined, and that reentry and focal discharges coexist. Multiple \u201cself-perpetuating wavelets\u201d have a role in the new model underlying AF, he said.\u003C\/p\u003E\n\u003Cp id=\u0022p-4\u0022\u003EIn the new \u201cintegrating\u201d paradigm, global atrial activation patterns seem to be generated by rapid, organized activations in the left atrium, fibrillatory conduction, and frequency breakdown. Focal activity may initiate and reinitiate reentry. Pulmonary veins and the adjacent left atrium play a key role as a source of focal activations and as sites of anisotropic reentry. Additionally, the autonomic nervous system may be involved in that cholinergic influences enhance reentry and fibrillatory conduction, and sympathetic-parasympathetic interactions enhance focal discharges, he said.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n\u003Ch2 class=\u0022\u0022\u003EVentricular Rate Control\u003C\/h2\u003E\n\u003Cp id=\u0022p-5\u0022\u003EA. John Camm, MD, of the University of London, United Kingdom, said that control of ventricular rate can be as effective as rhythm control (restoration and maintenance of sinus rhythm) in patients with paroxysmal or persistent AF and may be even preferred in asymptomatic, sedentary, or elderly patients. Beta blockade and calcium antagonism are the main therapies for rate control. Digoxin is useful in combination, in patients with heart failure, or in sedentary patients. Amiodarone may be used intravenously or orally when other therapies for rate control are not successful, and AV nodal ablation is applicable when other therapies fail. The appropriate heart rates for optimal symptom control and outcome have not yet been established with certainty.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n\u003Ch2 class=\u0022\u0022\u003ERadiofrequency Catheter Ablation\u003C\/h2\u003E\n\u003Cp id=\u0022p-6\u0022\u003EMost patients with AF tend to develop persistent disease with progressive substrate modification due to left atrial enlargement. While anti-arrhythmic drugs (AAD) such as amiodarone are effective in the early stage, most patients become unresponsive or develop side effects that lead to discontinuations in one third of patients later in follow-up, said Carlo Pappone, MD, PhD, of San Raffaele University Hospital, Milan, Italy.\u003C\/p\u003E\n\u003Cp id=\u0022p-7\u0022\u003E\u201cUnfortunately, 60% of patients have chronic AF and there is no chance to be cured without ablation,\u201d he said.\u003C\/p\u003E\n\u003Cp id=\u0022p-8\u0022\u003ECurrent guidelines for chronic AF suggest that catheter ablation be considered to maintain sinus rhythm in selected patients who fail to respond to AADs. The goals of AF ablation include pulmonary vein isolation, substrate modification, vagal denervation, and inability to induce AF or atrial tachycardia (AT), he said.\u003C\/p\u003E\n\u003Cp id=\u0022p-9\u0022\u003EIn Dr. Pappone\u0027s experience in over 14,000 patients, 87% achieve freedom from AF with ablation compared with 22% treated with amiodarone. Multiple studies have found ablation to be superior to drugs, he said, \u201cwhether patients are treated after an initial episode or after a long history of paroxysmal disease.\u201d\u003C\/p\u003E\n\u003Cp id=\u0022p-10\u0022\u003ESince the mechanisms of chronic AF are more complex than those causing paroxysmal AF, more extensive procedures that modify the electrical substrate as well as the initiators of AF are often necessary to prevent chronic disease. A stepwise, tailored approach to \u201cde-complexing the AF,\u201d substrate modification has rendered 90% of his patients free of AF at 1 year. He predicted that, in the future, clinicians will be able to construct a limited ablation procedure that targets the mechanisms unique to the individual and thus preserve the left atrium and prevent progression. Another promising treatment discussed by Ralph J. Damiano, MD, of Washington University School of Medicine, St. Louis, involves a minimally invasive surgical approach (simplified version of the Maze III procedure) that utilizes linear lines of transmural ablation that replicates the full lesions of the surgical incisions.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-5\u0022\u003E\n\u003Ch2 class=\u0022\u0022\u003EEmerging AAD Compounds\u003C\/h2\u003E\n\u003Cp id=\u0022p-11\u0022\u003EBramah N. Singh, MD, of the David Geffen School of Medicine, University of California, Los Angeles, said sinus rhythm should be the goal \u201cfor all patients in whom conversion and maintenance of sinus rhythm is possible.\u201d Drug development is aimed at this goal, with the major focus being two distinct categories of agents: 1) complex agents, specifically the de-iodinated amiodarone congeners dronedarone and SSR 149744C, and 2) simpler agents, ie, atrial-specific agents, such as RSD 1235 (Cardiome), a novel amino cyclohexyl ether drug with a unique Na ion channel blocking profile (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\n\u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/1\/25\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Augmenting Maintenance of Sinus Rhythm in Atrial Fibrillation by Antiarrhythmic Combinations \u0026#x2013; the Way of the Future?\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1808999836\u0022 data-figure-caption=\u0022Augmenting Maintenance of Sinus Rhythm in Atrial Fibrillation by Antiarrhythmic Combinations \u0026#x2013; the Way of the Future?\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/1\/25\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/1\/25\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/1\/25\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/10999\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \u003Cp id=\u0022p-12\u0022 class=\u0022first-child\u0022\u003EAugmenting Maintenance of Sinus Rhythm in Atrial Fibrillation by Antiarrhythmic Combinations \u2013 the Way of the Future?\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003Cp id=\u0022p-13\u0022\u003EDr. Pappone emphasized the need to individualize treatment. \u201cNo approach will be successful in 100% of patients.\u201d\u003C\/p\u003E\n\u003Cp id=\u0022p-14\u0022\u003EIn addition, patients should be counseled that repeat procedures may be required, particularly if there is recurrent pulmonary vein conduction, left atrial enlargement, or easy induced AF, said G. Neal Kay, MD, University of Alabama, Birmingham. Fortunately, the success of ablation is higher after repeat procedures and patients should be told to expect a second or third procedure to achieve long-term success.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2007 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/7\/1\/25.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmbe2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmbe2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}