Atrial Fibrillation Update: A Textbook of Cardiology Praveen Chandra, HK Chopra, GS Wander, Viveka Kumar
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fm1Atrial Fibrillation Updatefm2
A Textbook of Cardiology
fm3Atrial Fibrillation Update
A Textbook of Cardiology
Editors
HK Chopra Chairman, National CSI Affairs Advisory Committee National President, IAE, 2016–17 National President, CSI, 2015 Chairman, World Wellness Foundation Country Head, American Heart Association Sr Consultant Cardiologist, Moolchand Medcity New Delhi, India
GS Wander ‘Dr BC Roy’ Awardee President, API Chief Coordinator and Head Department of Cardiology Hero DMC Heart Institute Unit of DMC and Hospital Ludhiana, Punjab, India
Praveen Chandra ‘Padma Shri’ Awardee Chairman, Interventional Cardiology Medanta–The Medicity Gurugram, Haryana, India
Viveka Kumar Director, Cath Lab Senior Consultant Interventional Cardiologist and Electrophysiologist Max Super Speciality Hospital New Delhi, India
fm4
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Atrial Fibrillation Update: A Textbook of Cardiology
First Edition: 2017
9789386261953
fm5Co-Editors
AK Pancholia Chief Cardiologist Gokuldas Heart Center Indore, Madhya Pradesh, India
Satyendra Tiwari Professor Department of Cardiology SGPGIMS Lucknow, Uttar Pradesh, India
J Shiv Kumar Director and Head Department of Cardiology Apollo Hospital Secunderabad, Telangana, India
S Shanmugasundaram Emeritus Professor of Cardiology Tamil Nadu Medical University Billroth Hospitals Chennai, Tamil Nadu, India
Sameer Shrivastava Director and Head Non-invasive Cardiology Fortis Escorts Heart Institute New Delhi, India
Sandeep Bansal Professor and Head Department of Cardiology VMMC and Safdarjung Hospital New Delhi, India
CG Bahuleyan Chairman and Senior Consultant Cardiologist Cardiovascular Center Ananthapuri Hospitals and Research Institute Trivandrum, Keralas, India
NN Khanna Senior Consultant Interventional Cardiology and Vascular Interventions Apollo Group of Hospitals New Delhi, India
Ajay Kumar Sinha Consultant Interventional Cardiologist Suraksha Cardiac Care Paras-HMRI Hospital Patna, Bihar, India
JPS Sawhney Chairman Department of Cardiology Sir Ganga Ram Hospital New Delhi, India
B Ramesh Babu Senior Consultant Cardiologist Medwin Hospitals Hyderabad, Telangana, India
Vidyut Jain Senior Consultant Cardiologist Choithram Hospital and Research Center Indore, Madhya Pradesh, India
Aditya Kapoor Professor Department of Cardiology Sanjay Gandhi PGIMS Lucknow, Uttar Pradesh, India
S Ramakrishnan Additional Professor Department of Cardiology All India Institute of Medical Sciences New Delhi, Indiafm6
fm7Dedicated to
Cardiological Society of India, our parents, our teachers, all the members of CSI, our colleagues, patients, students and our families.fm8
fm9Contributors fm21Foreword
We are honored and have a great pleasure to write the Foreword for the state-of-the-art Atrial Fibrillation Update: A Textbook of Cardiology. The textbook on atrial fibrillation was long due considering the wealth of data and the new strategies to treat the most common arrhythmia encountered in clinical practice. It is one of the most needed, comprehensive, illustrative, well-structured book published for the ‘first-time ever’ from India and presented to cardiology community all over the world.
The management of atrial fibrillation has evolved rapidly over the last 100 years. The enormous benefits are shown by non-pharmacological, pharmacological, radiofrequency ablation, cryoablation, new oral anticoagulants (NOACs) for stroke prevention in atrial fibrillation (SPAF) in nonvalvular atrial fibrillation and, recently, the data on device closure of left atrial appendage. For the management of atrial fibrillation, an atrial fibrillation team involves partnership of physicians, clinical cardiologists, echocardiologists, intensivists, radiologists, interventional cardiologists, electrophysiologists, cardiac surgeons and rehabilitative cardiologists.
This book is an excellent and superior educational initiative, by the joint efforts of 4 editors, 14 co-editors and over 250 contributing authors. This book comprises seven sections, namely clinical spectrum of atrial fibrillation, diagnosis of atrial fibrillation, management strategies of atrial fibrillation, other arrhythmias and atrial fibrillation, interventions in atrial fibrillation, cardiac surgery and atrial fibrillation, future directions in atrial fibrillation, including a total of 146 chapters. Each chapter addresses a separate and distinct issue of clinical relevance. The chapters are well outlined, organized, well written and referenced. The writing style of every chapter is vivid, concise and practical. There are excellent graphics, tables and figures that present the relevant information. The printing and binding is of excellent quality. This book will represent a milestone for atrial fibrillation management strategies in the world.
We congratulate the editors Drs HK Chopra, GS Wander, Praveen Chandra, Viveka Kumar, all the co-editors, and the contributors, for accomplishing this prodigious achievement of great clinical relevance in cardiology practice today.
M Khalilullah Director and Senior Consultant Cardiologist, The Heart Centre Past President, National CSI New Delhi, India
DB Pahlajani Chief Interventional Cardiologist Breach Candy Hospital, Past President, National CSI Mumbai, Maharashtra, India
Amal Kumar Banerjee Past President, National CSI Past President, API Past President, SAARC CS Kolkata, West Bengal, India
Ashok Seth ‘Padma Bhushan’ and ‘Padma Shri’ Awardee Chairman, Fortis Escorts Heart Institute Past President, National CSI Vice President, APSC New Delhi, India
C Venkata S Ram Director, Apollo Institute for Blood Pressure Management World Hypertension League/South Asia Office Apollo Hospitals, Hyderabad, Telangana, India Texas Blood Pressure Institute, Dallas Nephrology Associates University of Texas, Southwestern Medical School, Dallas, Texas, USA
PK Deb Formerly Chief Cardiologist ESI PG Institute of Medical Sciences Past President, National CSI Kolkata, West Bengal, India
Santanu Guha Professor and Head, Department of Cardiology Medical College President, National CSI Kolkata, West Bengal, India
fm22fm23Preface
110 Years of Historical Revolution in Atrial Fibrillation
The chaotic irregularity of arterial pulse was clearly acknowledged by most of the physicians of the ancient China, Egypt and Greece. William Harvey (1578–1657), who first described the circulatory system appropriately was probably the first to describe fibrillation of the auricles in animals in 1628. The French ‘clinical pathologist’, Jean Baptist de Sénac (1693–1770), was the first, who assumed a correlation between ‘rebellious palpitation’ and stenosis of the mitral valve. Robert Adams (1791–1875) also reported in 1827 the association of irregular pulses and mitral stenosis. The discovery of digitalis leaf in 1785 by William Withering (1741–1799) brought relief to patients with atrial fibrillation (AF) and congestive heart failure, by reducing the ventricular rate. From an analysis of simultaneously recorded arterial and venous pressure curves, the Scottish, Sir James Mackenzie (1853–1925), demonstrated that a presystolic wave cannot be seen during ‘pulsus irregularis perpetuus’, a term very first used by Heinrich Ewald Hering (1866–1948). Arthur Cushny (1866–1926) noted the similarity between pulse curves in clinical ‘delirium cordis’ and those in dogs with atrial fibrillation.
The first human ECG depicting atrial fibrillation was published by Willem Einthoven in 1906 and subsequently by Sir Thomas Lewis brought atrial fibrillation ‘on the world map’. The proof of a direct connection between absolute arrhythmia and atrial fibrillation was established by two Viennese physicians, Carl Julius Rothberger and Heinrich Winterberg, in 1909. Sir Thomas Lewis (1881–1945), the Father of Modern Electrocardiography, studied electrophysiological characteristics of atrial fibrillation and showed that its basic perpetuating mechanism is circus movement of electrical impulse (re-entry). After him, the major discoveries relating to the pathophysiology and clinical features of atrial fibrillation in the 20th century came from Karel Frederick Wenckebach (1864–1940), Gordon Moe (1915–1989), Bernhard Lown and Maurits Allessie. The recent explosion of literature on atrial fibrillation in the last 16 years is very impressive as evident by almost 1,02,00,000 publications in AF (2000–2016), awareness has increased in the prevalence of AF. It is a major public problem with high prevalence of hypertension, heart failure, coronary artery disease and diabetes mellitus. Its prevalence is 2% at the age of 40 years and increases as the age advances with associated comorbidity, 4% at the age of 50 years, 6% at the age of 60 years, 8% at the age of 70 years and more than 10% at the age of 80 years. About 50% of AF-related stroke die within a year. It has been estimated that there are 14 crore patients of AF in the world. The advances in echocardiography, including 2D echo, transesophageal echocardiography (TEE), 3D echo, conventional Doppler, tissue Doppler imaging (TDI), 2D echo speckle tracking, strain and strain rate, left ventricular (LV) torsion, left atrial (LA) stiffness index, have revolutionized AF evaluation. The therapeutic approach from rate versus rhythm control by antiarrhythmic drugs to transcatheter radiofrequency and cryoablation of non-valvular atrial fibrillation and the battle against formation of intraatrial thrombi for preventing cerebral thromboembolism is also undergoing tremendous advances. Recently, the development of oral anticoagulants (OAC); vitamin-K antagonists in 1954, to new oral anticoagulants (NOACs), including direct thrombin antagonists, such as debigatran in 2009, factor Xa antagonist, including rivaroxaban, apixban and edoxaban in 2010, 2011 and 2013, respectively, has revolutionized stroke prevention in atrial fibrillation (SPAF) in nonvalvular AF (NVAF) management strategies.
We are sure that advances in antiarrhythmic drugs, NOACs, radiofrequency ablation, cryoablation and device closure of left atrial appendage with enormous incremental data, will definitely help in reducing AF-inflicted morbidity and mortality in the future.
HK Chopra, GS Wander
Praveen Chandra, Viveka Kumar
fm24fm25The scientific committee of Atrial Fibrillation Update: A Textbook of Cardiology express their gratitude and thanks to
Platinum Academic Partner
USV Limited
Gold Academic Partners
Sun Pharmaceutical Industries Ltd
Abbott Healthcare Pvt Ltd
Lupin Limited
Medtronic India
St Jude India
Emcure Pharmaceutical Ltd
Merck Limited
Zydus Cadila Healthcare
Boston Scientific
Biotronic India
Silver Academic Partners
Sanofi Aventis   Eris Lifesciences
Bronze Academic Partners
Allengers   Nutrabuff
For rendering unrestricted education grant, which made this book possible in its current enhanced form as ‘Global Education Initiative’.