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JADA Continuing Education

Pathogenesis, Medical-Surgical Management and Dental Implications

Background. Atrial fibrillation (AF) is a cardiac rhythm disturbance arising from disorganized electrical activity in the atria, and it is accompanied by an irregular and often rapid ventricular response. It is the most common clinically significant dysrhythmia in the general and older population.

Types of Studies Reviewed. The authors conducted a MEDLINE search using the key terms "atrial fibrillation," "epidemiology," "pathophysiology," "treatment" and "dentistry." They selected contemporaneous articles published in peer-reviewed journals and gave preference to articles reporting randomized controlled trials.

Clinical Implications. The anticoagulant warfarin frequently is prescribed to prevent stroke caused by cardiogenic thromboemboli arising from stagnant blood in poorly contracting atria. Most dental procedures and a limited number of surgical procedures can be performed without altering warfarin dosage if the international normalized ratio value is within the therapeutic range of 2.0 to 3.0. Certain analgesic agents, antibiotic agents, antifungal agents and sedative hypnotics, however, should not be prescribed without consultation with the patient’s physician because these medications may alter the patient’s risk of hemorrhage and stroke.

Conclusions. AF affects nearly 2.5 million Americans, most of who are older than 60 years. Consultation with the patient’s physician to discuss the planned dental treatment often is appropriate, especially for people who frequently have comorbid diseases such as coronary artery disease, congestive heart failure, diabetes and thyrotoxicosis, which are treated with multiple drug regimens.

Key Words: Cardiovascular diseases; stroke; anticoagulation therapy

Abbreviations: ADA CSA: American Dental Association Council on Scientific Affairs. • AHA: American Heart Association. • AF: Atrial fibrillation. • ASA: Acetylsalicylic acid. • AV: Atrioventricular. • ECG: Electrocardiogram. • INR: International normalized ratio. • LMWH: Low-molecular-weight heparin. • NSAID: Nonsteroidal anti-inflammatory drug. • PV: Pulmonary veins. • SA: Sinoatrial.