<s>
The	O
management	B-Algorithm
of	I-Algorithm
atrial	I-Algorithm
fibrillation	I-Algorithm
(	O
AF	O
)	O
is	O
focused	O
on	O
preventing	O
temporary	O
circulatory	O
instability	O
,	O
stroke	O
and	O
other	O
ischemic	O
events	O
.	O
</s>
<s>
Within	O
the	O
context	O
of	O
stroke	O
,	O
the	O
discipline	O
may	O
be	O
referred	O
to	O
as	O
stroke	O
prevention	O
in	O
atrial	B-Application
fibrillation	I-Application
(	O
SPAF	O
)	O
.	O
</s>
<s>
In	O
emergencies	O
,	O
when	O
circulatory	O
collapse	O
is	O
imminent	O
due	O
to	O
uncontrolled	O
rapid	B-Application
heart	I-Application
rate	I-Application
,	O
immediate	O
cardioversion	O
may	O
be	O
indicated	O
.	O
</s>
<s>
If	O
rate	O
and	O
rhythm	O
control	O
cannot	O
be	O
maintained	O
by	O
medication	O
or	O
cardioversion	O
,	O
it	O
may	O
be	O
necessary	O
to	O
perform	O
electrophysiological	B-Algorithm
studies	I-Algorithm
with	O
ablation	B-Algorithm
of	O
abnormal	O
electrical	O
pathways	O
.	O
</s>
<s>
Patients	O
can	O
be	O
classified	O
,	O
based	O
on	O
how	O
much	O
they	O
are	O
limited	O
during	O
physical	O
activity	O
,	O
according	O
to	O
the	O
European	O
Heart	O
Rhythm	O
Association	O
score	O
of	O
atrial	B-Application
fibrillation	I-Application
.	O
</s>
<s>
To	O
complement	O
the	O
CHADS2	O
score	O
,	O
the	O
ESC	O
guidelines	O
on	O
atrial	B-Application
fibrillation	I-Application
management	O
recommend	O
using	O
the	O
new	O
CHA2DS2-VASc	O
score	O
(	O
Congestive	O
heart	O
failure	O
,	O
Hypertension	O
,	O
Age	O
≥75	O
years	O
(	O
doubled	O
)	O
,	O
Diabetes	O
mellitus	O
,	O
Stroke	O
(	O
doubled	O
)	O
,	O
Vascular	O
disease	O
,	O
Age	O
65	O
–	O
74	O
years	O
,	O
Sex	O
category ]	O
,	O
which	O
is	O
more	O
inclusive	O
of	O
'	O
stroke	O
risk	O
modifier	O
 '	O
risk	O
factors	O
.	O
</s>
<s>
Latest	O
ESC	O
guidelines	O
on	O
atrial	B-Application
fibrillation	I-Application
recommend	O
assessment	O
of	O
bleeding	O
risk	O
in	O
AF	O
using	O
the	O
HAS-BLED	O
(	O
Hypertension	O
,	O
Abnormal	O
renal/liver	O
function	O
,	O
Stroke	O
,	O
Bleeding	O
history	O
or	O
predisposition	O
,	O
Labile	O
International	O
Normalized	O
Ratio	O
,	O
Elderly	O
,	O
Drugs/alcohol	O
concomitantly	O
)	O
bleeding	O
risk	O
schema	O
as	O
a	O
simple	O
,	O
easy	O
calculation	O
,	O
whereby	O
a	O
score	O
of	O
≥3	O
indicates	O
"	O
high	O
risk	O
"	O
and	O
some	O
caution	O
and	O
regular	O
review	O
of	O
the	O
patient	O
is	O
needed	O
.	O
</s>
<s>
The	O
U.S.	O
Food	O
and	O
Drug	O
Administration	O
(	O
FDA	O
)	O
approved	O
Dabigatran	O
(	O
"	O
Pradaxa	O
,	O
"	O
and	O
other	O
names	O
)	O
on	O
19	O
October	O
2010	O
,	O
for	O
prevention	O
of	O
stroke	O
in	O
patients	O
with	O
non-valvular	B-Application
atrial	I-Application
fibrillation	I-Application
.	O
</s>
<s>
Palpitations	B-Algorithm
,	O
angina	O
,	O
lassitude	O
(	O
weariness	O
)	O
,	O
and	O
decreased	O
exercise	O
tolerance	O
are	O
related	O
to	O
rapid	B-Application
heart	I-Application
rate	I-Application
and	O
inefficient	O
cardiac	O
output	O
caused	O
by	O
AF	O
.	O
</s>
<s>
Furthermore	O
,	O
AF	O
with	O
a	O
persistent	O
rapid	O
rate	O
can	O
cause	O
a	O
form	O
of	O
heart	O
failure	O
called	O
tachycardia-induced	O
cardiomyopathy	O
.	O
</s>
<s>
Cardioversion	O
may	O
be	O
performed	O
in	O
instances	O
of	O
AF	O
lasting	O
more	O
than	O
48hours	O
if	O
a	O
transesophogeal	B-Algorithm
echocardiogram	I-Algorithm
(	O
TEE	O
)	O
demonstrates	O
no	O
evidence	O
of	O
clot	O
within	O
the	O
heart	O
.	O
</s>
<s>
The	O
agents	O
work	O
by	O
prolonging	O
the	O
Effective	B-Algorithm
Refractory	I-Algorithm
Period	I-Algorithm
(	O
ERP	O
)	O
either	O
by	O
blocking	O
sodium	O
ions	O
(	O
Class	O
I	O
drugs	O
)	O
or	O
by	O
blocking	O
potassium	O
ions	O
(	O
Class	O
III	O
drugs	O
)	O
or	O
a	O
mixture	O
of	O
both	O
.	O
</s>
<s>
For	O
example	O
,	O
to	O
control	O
rate	O
it	O
is	O
possible	O
to	O
destroy	O
the	O
bundle	O
of	O
cells	O
connecting	O
the	O
upper	O
and	O
lower	O
chambers	O
of	O
the	O
heart	O
–	O
the	O
atrioventricular	O
node	O
–	O
which	O
regulates	O
heart	O
rate	O
,	O
and	O
to	O
implant	O
a	O
pacemaker	B-Device
instead	O
.	O
</s>
<s>
Ablation	B-Algorithm
(	O
AF	O
ablation	B-Algorithm
)	O
is	O
a	O
method	O
that	O
increasingly	O
is	O
used	O
to	O
treat	O
cases	O
of	O
recurrent	O
AF	O
that	O
are	O
unresponsive	O
to	O
conventional	O
treatments	O
.	O
</s>
<s>
Radiofrequency	O
ablation	B-Algorithm
(	O
RFA	O
)	O
uses	O
radiofrequency	O
energy	O
to	O
destroy	O
abnormal	O
electrical	O
pathways	O
in	O
heart	O
tissue	O
.	O
</s>
<s>
Efficacy	O
and	O
risks	O
of	O
catheter	O
ablation	B-Algorithm
of	O
AF	O
are	O
areas	O
of	O
active	O
debate	O
.	O
</s>
<s>
A	O
worldwide	O
survey	O
of	O
the	O
outcomes	O
of	O
8745	O
ablation	B-Algorithm
procedures	O
demonstrated	O
a	O
52%	O
success	O
rate	O
(	O
ranging	O
from	O
14.5	O
%	O
to	O
76.5	O
%	O
among	O
centers	O
)	O
,	O
with	O
an	O
additional	O
23.9	O
%	O
of	O
patients	O
becoming	O
asymptomatic	O
with	O
addition	O
of	O
an	O
antiarrhythmic	O
medication	O
.	O
</s>
<s>
A	O
thorough	O
discussion	O
of	O
results	O
of	O
catheter	O
ablation	B-Algorithm
was	O
published	O
in	O
2007	O
;	O
it	O
notes	O
that	O
results	O
are	O
widely	O
variable	O
,	O
due	O
in	O
part	O
to	O
differences	O
in	O
technique	O
,	O
follow-up	O
,	O
definitions	O
of	O
success	O
,	O
use	O
of	O
antiarrhythmic	O
therapy	O
,	O
and	O
in	O
experience	O
and	O
technical	O
proficiency	O
.	O
</s>
<s>
Minimaze	B-Algorithm
procedures	I-Algorithm
are	O
minimally	O
invasive	O
versions	O
of	O
the	O
original	O
Cox	O
maze	O
procedure	O
but	O
without	O
cardiac	O
incisions	O
.	O
</s>
<s>
They	O
use	O
laser	O
,	O
cryothermy	O
,	O
radiofrequency	O
,	O
or	O
acoustic	O
energy	O
to	O
ablate	O
atrial	O
tissue	O
near	O
the	O
pulmonary	O
veins	O
and	O
make	O
other	O
required	O
ablations	B-Algorithm
to	O
mimic	O
the	O
maze	O
.	O
</s>
<s>
Minimally	O
invasive	O
surgical	O
(	O
endoscopic	B-Application
)	O
maze	O
procedures	O
are	O
now	O
routinely	O
conducted	O
at	O
hospitals	O
around	O
the	O
US	O
.	O
</s>
<s>
Two	O
2021	O
systematic	O
reviews	O
and	O
meta-analyses	O
concluded	O
that	O
more	O
than	O
1	O
g/d	O
marine	O
omega-3	O
fatty	O
acids	O
is	O
associated	O
with	O
an	O
increased	O
risk	O
of	O
atrial	B-Application
fibrillation	I-Application
(	O
AF	O
)	O
.	O
</s>
