Tailored treatment strategies: a new approach for modern management of atrial fibrillation

Autor: Ulrich Schotten, Riccardo Cappato, I. C. Van Gelder, Thorsten Lewalter, J. Schwieler, Michiel Rienstra, Giuseppe Boriani, Ernaldo G. Marcos, Anne H Hobbelt
Přispěvatelé: RS: CARIM - R2.11 - Experimental atrial fibrillation, Fysiologie
Rok vydání: 2016
Předmět:
CHRONIC KIDNEY-DISEASE
Male
medicine.medical_treatment
Management of atrial fibrillation
030204 cardiovascular system & hematology
Bioinformatics
law.invention
0302 clinical medicine
Randomized controlled trial
Quality of life
law
Recurrence
Risk Factors
Atrial Fibrillation
genetics
030212 general & internal medicine
Anticoagulation
Arrhythmia
Atrial fibrillation
Catheter ablation
Genetics
Risk factors
Adult
Aged
Anti-Arrhythmia Agents
Anticoagulants
Biomarkers
Catheter Ablation
Female
Genotype
Humans
Kidney Failure
Chronic
Middle Aged
Phenotype
Precision Medicine
Internal Medicine
anticoagulation
RISK
Anticoagulant
EUROPEAN-SOCIETY
RANDOMIZED CLINICAL-TRIAL
Cardiology
PREDICTING STROKE
APPENDAGE OCCLUSION
medicine.medical_specialty
medicine.drug_class
arrhythmia
03 medical and health sciences
Pharmacotherapy
Internal medicine
medicine
CHROMOSOME 4Q25
EXPERT CONSENSUS STATEMENT
business.industry
HEART RHYTHM ASSOCIATION
Precision medicine
medicine.disease
business
CONTROL THERAPY
Zdroj: Journal of Internal Medicine, 279(5), 457-466. Wiley
ISSN: 1365-2796
0954-6820
Popis: Atrial fibrillation (AF) is not benign. Cardiovascular diseases and risk factors differ importantly amongst patients. Careful phenotyping with the aim to start tailored therapy may improve outcome and quality of life. Furthermore, structural remodelling plays an important role in initiation and progression of AF. Therapies that interfere in the remodelling processes are promising because they may modify the atrial substrate. However, success is still limited probably due to variations in the underlying substrate in individual patients. The most favourable effects of lifestyle changes on success of rhythm control have been demonstrated in obese patients with AF. Differences in genotype may also play an important role. Common gene variants have been associated with recurrence of AF after electrical cardioversion, antiarrhythmic drug therapy and catheter ablation. Therefore, both phenotyping and genotyping may become useful for patient selection in the future. Beside the choice of rate or rhythm control, and type of rhythm control, prevention of complications associated with AF may also differ depending on genotype and phenotype. Efficacy of stroke prevention has been well established, but bleeding remains a clinically relevant problem. Risk stratification is still cumbersome, especially in low-risk patients and in those with a high bleeding risk. The decision whether to start anticoagulation (and if so which type of anticoagulant) or, alternatively, to implant an occlusion device of the left atrial appendage may also be improved by genotyping and phenotyping. In this review, we will summarize new insights into the roles of phenotype and genotype in generating more tailored treatment strategies in patients with AF and discuss several patient-tailored treatment options.
Databáze: OpenAIRE
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