Nonpharmacological Approach to Managing Atrial Fibrillation: A Review

Francis C. Ifiora

Department of Pharmacy, University of Texas Health Science Center at Houston, Houston, USA.

Ginikachukwu M. Agudosi

Department of Internal Medicine, Trinity School of Medicine, Warner Robins, USA.

Chinwendum U. Ekpemiro

Department of Surgery, Federal Medical Centre, Umuahia, Nigeria.

Valentine C. Keke

Department of Internal Medicine, University of Nigeria, Enugu, Nigeria.

Pedro Okoh

Department of Emergency Medicine, Lancashire Teaching Hospital, Preston, England.

Abiola Y. Oyesile

Department of Medicine, Dnipropetrovsk Medical Institute, Dnipropetrovsk, Ukraine.

Linda A. Mbah

Department of Internal Medicine, Veterans Affairs, Indiana, USA.

Ngozi T. Akueme

Department of Dermatology, University of Medical Sciences (UNIMEDTH), Ondo State, Nigeria.

Oyewole Emmanuel Akanle

Ladoke Akintola University of Technology, Ogbomosho, Oyo-State, Nigeria.

Romanus Anebere

Imo State University, Owerri, Imo State, Nigeria.

Moses, Chukwuebuka Odoeke

University of Nigeria Nsukka, Nigeria.

Yetunde Ishola

Oba Okunade Sijuade College of Health Sciences Igbinedion University, Okada, Edo State, Nigeria.

Okelue E. Okobi *

Department of Family Medicine, Larkin Community Hospital, Palm Springs Campus, Miami, USA.

*Author to whom correspondence should be addressed.


Background: AF's global prevalence underscores its significance as a cardiac rhythm disorder that disrupts atrial activity, impairing normal cardiac function. Over five decades of study have illuminated the pathophysiological mechanisms underlying AF, including insights into re-entrant waves and macro-reentrant circuits. The emergence of non-uniform conduction patterns and bidirectional block regions has further enriched our understanding. Risk factors contributing to AF development encompass cardiovascular conditions, advanced age, and atrial structural changes. With its implications on stroke risk and cardiovascular health, AF has become a growing public health concern. The focus on AF epidemiology has expanded, with attention on the relationship between left atrial size and AF development. Individuals with larger left atria exhibit a heightened risk. Additionally, the elevated stroke risk associated with AF has been consistently documented.

To optimize clinical management, distinctions are drawn between chronic and paroxysmal AF, as well as the presence of structural heart disease. Mapping techniques have revealed insights into "atrial remodeling" and AF pathology. In managing AF, controlling heart rate, preventing clot formation, and restoring sinus rhythm are principal objectives. This article categorizes AF into acute, chronic, stable, or unstable forms, tailoring management approaches accordingly. While pharmacological interventions have shown efficacy, their limitations drive the exploration of nonpharmacological strategies. Approaches range from medications to cardioversion, including electrical and pharmacological methods.

Objective: This paper aimed to provide a comprehensive exploration of non-pharmacological approaches to AF management.

Methodology: This paper employed a structured methodology. This method involved a literature review, data synthesis, and critical analysis. During the literature review phase, we systematically searched electronic databases (PubMed, MEDLINE, Embase, and Google Scholar) for studies published from 1960 to 2023. Specific keywords and phrases such as "atrial fibrillation," "non-pharmacological interventions," "electrical cardioversion," "catheter ablation," "lifestyle modifications," "autonomic modulation," "left atrial appendage closure," and "exercise" were used. Our inclusion criteria encompassed studies addressing various non-pharmacological approaches for AF management, including observational studies and randomized controlled trials.

Result: The initial stage of our study involved the identification of a substantial number of relevant studies. We conducted a thorough literature search across multiple databases, using specific search terms and criteria relevant to our research topic. This comprehensive search yielded a total of 1,200 studies. After applying these stringent filtering criteria, we were left with 350 studies. To further refine our final sample and categorize the studies according to type, we conducted a detailed review of the remaining 350 studies. We categorized them into various types based on study design, methodology, and focus. We then also excluded studies with duplicate ideas and finally included 103 studies that addressed the objective of our research plan. (See reference list [1-103]).

Conclusion: This reviewed a number of non-pharmacological approaches including electrical cardioversion, catheter ablation, lifestyle modifications, autonomic modulation, left atrial appendage closure, and exercise, the paper delves into each method's advantages, potential risks, techniques, and efficacy. By offering this extensive overview, the article contributes to the expanding repository of knowledge on non-pharmacological approaches for AF management. These approaches offer potential for unique management of atrial fibrillations or in addition to pharmacologic management, may improve patient survivability or reduce complication outcomes.

In the management of Atrial fibrillation, choice between rhythm and rate control, lifestyle modifications, and patient adherence to treatment plans are critical factors influencing outcomes are factors to consider. Emerging therapies offer promise, but timely diagnosis, individualized care, and ongoing monitoring remain essential to improving AF patients' overall prognosis.

Keywords: Cardiovascular health, left atrial size, pathophysiological mechanisms, af management, cardiac arrhythmia, non-pharmacological approaches, atrial fibrillation

How to Cite

Ifiora , F. C., Agudosi , G. M., Ekpemiro , C. U., Keke , V. C., Okoh , P., Oyesile , A. Y., Mbah , L. A., Akueme , N. T., Akanle , O. E., Anebere , R., Odoeke , M. C., Ishola , Y., & Okobi , O. E. (2023). Nonpharmacological Approach to Managing Atrial Fibrillation: A Review . Cardiology and Angiology: An International Journal, 12(4), 234–255.


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