Gestione e trattamento dei pazienti con fibrillazione atriale con accesso presso l'Azienda Ospedaliera Universitaria Pisana

Abstract

Atrial fibrillation (AF) represents the most frequent cardiac arrhythmia in clinical practice and is today considered one of the main health challenges in the cardiovascular field. Its relevance derives not only from the high prevalence in the general population, but above all from the association with a significant increase in morbidity and mortality, in particular due to the risk of ischemic stroke, heart failure, recurrent hospitalizations, and functional decline, with a relevant impact on patients’ quality of life and on healthcare costs. From a historical point of view, irregularity of the pulse was one of the first clinical alterations described in medicine; however, only with the introduction of electrocardiography at the beginning of the twentieth century was it possible to define atrial fibrillation in a systematic way as an autonomous entity. Since then, AF has become the object of growing clinical and scientific interest, parallel to the evolution of pathophysiological knowledge and to the development of increasingly sophisticated diagnostic and therapeutic strategies. As regards pathophysiology, AF is characterized by disorganized atrial electrical activity that determines the loss of effective atrial contraction, with consequent compromise of hemodynamic efficiency and increase in thromboembolic risk. Cardioembolic stroke represents the most feared complication and is responsible for a relevant proportion of permanent disability and mortality. At the electrocardiographic level, AF manifests itself with the absence of P waves and the presence of fibrillatory waves of variable amplitude and morphology (f waves), associated with an irregular ventricular response, which is expressed with irregularity of the R–R intervals. In recent decades, the understanding of atrial fibrillation has profoundly evolved. It is no longer considered a static condition, but a dynamic and progressive pathology, which tends to evolve over time from paroxysmal forms to persistent and permanent forms. This continuum is supported by processes of electrical and structural remodeling of the atria, which contribute to the progressive stabilization of the arrhythmia and to the reduction of the effectiveness of therapeutic strategies. In light of such considerations, atrial fibrillation represents a topic of primary importance in modern medicine. Early identification, stratification of thromboembolic and hemorrhagic risk, and the definition of appropriate therapeutic strategies, including control of rate or rhythm and correct anticoagulant therapy, constitute fundamental elements for improving prognosis and patients’ quality of life. The growing interest toward integrated and personalized approaches reflects the complexity of this arrhythmia and the necessity of rigorous and evidence-based clinical management