Semin Thromb Hemost 2017; 43(08): 849-863
DOI: 10.1055/s-0036-1598005
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pulmonary Embolism and Atrial Fibrillation: Two Sides of the Same Coin? A Systematic Review

Behnood Bikdeli
1   Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
2   New York-Presbyterian Hospital, New York, New York
3   Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, Connecticut
,
Maen D. Abou Ziki
4   Yale University School of Medicine, New Haven, Connecticut
,
Gregory Y. H. Lip
5   University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
6   Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
› Author Affiliations
Further Information

Publication History

Publication Date:
14 February 2017 (online)

Abstract

Pulmonary embolism (PE) is a common, potentially fatal thrombotic disease. Atrial fibrillation (AF), the most common arrhythmia, may also lead to thromboembolic complications. Although initially appearing as distinct entities, PE and AF may coexist. The direction and extent of this association has not been well characterized. We performed a search of PubMed, Scopus, and the Cochrane Database of Systematic Reviews for publications that reported coexisting AF in patients with PE, or vice versa, to provide a systematic overview of pathophysiological and epidemiological aspects of this association (last search: October 13, 2016). We screened 650 articles following the PubMed search, and 697 through Scopus. PE and AF share many common risk factors, including old age, obesity, heart failure, and inflammatory states. In addition, PE may lead to AF through right-sided pressure overload or inflammatory cytokines. AF, in turn, might lead to right atrial appendage clot formation and thereby PE. Epidemiological studies indicate that AF can be seen as a presenting sign, during the early phase, or later in the course of recovery from PE. Patients with AF are also at increased risk of developing PE, a risk that correlates with the CHA2DS2-VASc score. For the choice of antithrombotic therapy, PE-related factors (provoked or unproved, active cancer, and prior recurrence) and AF-related factors (CHA2DS2-VASc score), risk of bleeding, and patient preferences should be considered. In conclusion, PE and AF may coexist, with an understudied bidirectional association. Prognostication and choice of antithrombotic therapy in patients with both PE and AF might be different compared with those who present with only one of the two and warrants further investigation.

Authors' Contributions

Study design: B.B., G.Y.H.L. Literature search and data collection: B.B., M.A.Z. Summarization and statistical analysis: B.B., M.A.Z. Drafting the manuscript: B.B. Critical revisions: B.B., M.A.Z., G.Y.H.L.


 
  • References

  • 1 Bikdeli B, Gupta A, Mody P, Lampropulos JF, Dharmarajan K. Most important outcomes research papers on anticoagulation for cardiovascular disease. Circ Cardiovasc Qual Outcomes 2012; 5 (05) e65-e74
  • 2 Raskob GE, Angchaisuksiri P, Blanco AN. , et al; ISTH Steering Committee for World Thrombosis Day. Thrombosis: a major contributor to global disease burden. Semin Thromb Hemost 2014; 40 (07) 724-735
  • 3 Heit JA, Cohen AT, Anderson FJ. Estimated annual number of incident and recurrent, non-fatal and fatal venous thromboembolism (VTE) events in the US. Blood 2005; 106: 1
  • 4 Cohen AT, Agnelli G, Anderson FA. , et al; VTE Impact Assessment Group in Europe (VITAE). Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007; 98 (04) 756-764
  • 5 Bikdeli B, Bikdeli B. Updates on advanced therapies for acute pulmonary embolism. Int J Cardiovasc Pract 2016;
  • 6 Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation: a major contributor to stroke in the elderly. The Framingham Study. Arch Intern Med 1987; 147 (09) 1561-1564
  • 7 Flegel KM. When atrial fibrillation occurs with pulmonary embolism, is it the chicken or the egg?. CMAJ 1999; 160 (08) 1181-1182
  • 8 O'Toole L, McLean KA, Channer KS. Pulmonary embolism presenting with atrial fibrillation. Lancet 1993; 342 (8878): 1050
  • 9 Klein HO, Bakst A, Kaplinsky E. Pulmonary embolism and atrial fibrillation. Am J Cardiol 1988; 61 (06) 498-499
  • 10 Watanabe H, Tanabe N, Watanabe T. , et al. Metabolic syndrome and risk of development of atrial fibrillation: the Niigata preventive medicine study. Circulation 2008; 117 (10) 1255-1260
  • 11 Frost L, Hune LJ, Vestergaard P. Overweight and obesity as risk factors for atrial fibrillation or flutter: the Danish Diet, Cancer, and Health Study. Am J Med 2005; 118 (05) 489-495
  • 12 Kim YH, Lim DS, Lee JH. , et al. Gene expression profiling of oxidative stress on atrial fibrillation in humans. Exp Mol Med 2003; 35 (05) 336-349
  • 13 Magnani JW, Hylek EM, Apovian CM. Obesity begets atrial fibrillation: a contemporary summary. Circulation 2013; 128 (04) 401-405
  • 14 Stein PD, Matta F, Goldman J. Obesity and pulmonary embolism: the mounting evidence of risk and the mortality paradox. Thromb Res 2011; 128 (06) 518-523
  • 15 Basili S, Pacini G, Guagnano MT. , et al. Insulin resistance as a determinant of platelet activation in obese women. J Am Coll Cardiol 2006; 48 (12) 2531-2538
  • 16 Mertens I, Van Gaal LF. Obesity, haemostasis and the fibrinolytic system. Obes Rev 2002; 3 (02) 85-101
  • 17 Burstein B, Nattel S. Atrial fibrosis: mechanisms and clinical relevance in atrial fibrillation. J Am Coll Cardiol 2008; 51 (08) 802-809
  • 18 Piazza G, Goldhaber SZ. Pulmonary embolism in heart failure. Circulation 2008; 118 (15) 1598-1601
  • 19 Anker SD, von Haehling S. Inflammatory mediators in chronic heart failure: an overview. Heart 2004; 90 (04) 464-470
  • 20 Kuipers S, Klein Klouwenberg PM, Cremer OL. Incidence, risk factors and outcomes of new-onset atrial fibrillation in patients with sepsis: a systematic review. Crit Care 2014; 18 (06) 688
  • 21 Kaplan D, Casper TC, Elliott CG. , et al. VTE incidence and risk factors in patients with severe sepsis and septic shock. Chest 2015; 148 (05) 1224-1230
  • 22 Lazzerini PE, Capecchi PL, Acampa M, Galeazzi M, Laghi-Pasini F. Arrhythmic risk in rheumatoid arthritis: the driving role of systemic inflammation. Autoimmun Rev 2014; 13 (09) 936-944
  • 23 Lindhardsen J, Ahlehoff O, Gislason GH. , et al. Risk of atrial fibrillation and stroke in rheumatoid arthritis: Danish nationwide cohort study. BMJ 2012; 344: e1257
  • 24 Chung WS, Peng CL, Lin CL. , et al. Rheumatoid arthritis increases the risk of deep vein thrombosis and pulmonary thromboembolism: a nationwide cohort study. Ann Rheum Dis 2014; 73 (10) 1774-1780
  • 25 van den Oever IA, Sattar N, Nurmohamed MT. Thromboembolic and cardiovascular risk in rheumatoid arthritis: role of the haemostatic system. Ann Rheum Dis 2014; 73 (06) 954-957
  • 26 Ko D, Hylek EM. Anticoagulation in the older adult: optimizing benefit and reducing risk. Semin Thromb Hemost 2014; 40 (06) 688-694
  • 27 Franken RA, Rosa RF, Santos SC. Atrial fibrillation in the elderly. J Geriatr Cardiol 2012; 9 (02) 91-100
  • 28 Michaud M, Balardy L, Moulis G. , et al. Proinflammatory cytokines, aging, and age-related diseases. J Am Med Dir Assoc 2013; 14 (12) 877-882
  • 29 Dall'Olio F, Vanhooren V, Chen CC, Slagboom PE, Wuhrer M, Franceschi C. N-glycomic biomarkers of biological aging and longevity: a link with inflammaging. Ageing Res Rev 2013; 12 (02) 685-698
  • 30 Franceschi C, Campisi J. Chronic inflammation (inflammaging) and its potential contribution to age-associated diseases. J Gerontol A Biol Sci Med Sci 2014; 69 (Suppl. 01) S4-S9
  • 31 Berman AR. Pulmonary embolism in the elderly. Clin Geriatr Med 2001; 17 (01) 107-130
  • 32 Silverstein MD, Heit JA, Mohr DN, Petterson TM, O'Fallon WM, Melton III LJ. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998; 158 (06) 585-593
  • 33 Matthews JC, McLaughlin V. Acute right ventricular failure in the setting of acute pulmonary embolism or chronic pulmonary hypertension: a detailed review of the pathophysiology, diagnosis, and management. Curr Cardiol Rev 2008; 4 (01) 49-59
  • 34 Yusuf S, Al-Saady N, Camm AJ. 5-hydroxytryptamine and atrial fibrillation: how significant is this piece in the puzzle?. J Cardiovasc Electrophysiol 2003; 14 (02) 209-214
  • 35 Kline JA, Steuerwald MT, Marchick MR, Hernandez-Nino J, Rose GA. Prospective evaluation of right ventricular function and functional status 6 months after acute submassive pulmonary embolism: frequency of persistent or subsequent elevation in estimated pulmonary artery pressure. Chest 2009; 136 (05) 1202-1210
  • 36 Williams PL, Bannister LH. , eds. Gray's Anatomy: The Anatomical Basis of Medicine and Surgery. 38th ed. London: Churchill Livingstone; 1995: 1477-1482
  • 37 Kukla P, McIntyre WF, Koracevic G. , et al. Relation of atrial fibrillation and right-sided cardiac thrombus to outcomes in patients with acute pulmonary embolism. Am J Cardiol 2015; 115 (06) 825-830
  • 38 Ishihara Y, Hara H, Saijo T. , et al. Left atrial thrombus causing pulmonary embolism by passing through an atrial septal defect. Circ J 2002; 66 (01) 109-110
  • 39 Murnaghan D, McGinn S, White PD. Pulmonary embolism with and without acute cor pulmonale, with especial reference to the electrocardiogram. Am Heart J 1943; 25: 573-597
  • 40 Cutforth RH, Oram S. The electrocardiogram in pulmonary embolism. Br Heart J 1958; 20 (01) 41-60
  • 41 Caird FI, Stanfield CA. The electrocardiogram in asphyxial and in embolic acute cor pulmonale. Br Heart J 1962; 24: 313-323
  • 42 Szucs Jr MM, Brooks HL, Grossman W. , et al. Diagnostic sensitivity of laboratory findings in acute pulmonary embolism. Ann Intern Med 1971; 74 (02) 161-166
  • 43 Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999; 353 (9162): 1386-1389
  • 44 Rodger M, Makropoulos D, Turek M. , et al. Diagnostic value of the electrocardiogram in suspected pulmonary embolism. Am J Cardiol 2000; 86 (07) 807-809 , A10
  • 45 Kucher N, Walpoth N, Wustmann K, Noveanu M, Gertsch M. QR in V1--an ECG sign associated with right ventricular strain and adverse clinical outcome in pulmonary embolism. Eur Heart J 2003; 24 (12) 1113-1119
  • 46 Richman PB, Loutfi H, Lester SJ. , et al. Electrocardiographic findings in Emergency Department patients with pulmonary embolism. J Emerg Med 2004; 27 (02) 121-126
  • 47 Jankowski K, Kostrubiec M, Ozdowska P. , et al. Electrocardiographic differentiation between acute pulmonary embolism and non-ST elevation acute coronary syndromes at the bedside. Ann Noninvasive Electrocardiol 2010; 15 (02) 145-150
  • 48 Ryu HM, Lee JH, Kwon YS. , et al. Electrocardiography patterns and the role of the electrocardiography score for risk stratification in acute pulmonary embolism. Korean Circ J 2010; 40 (10) 499-506
  • 49 Kukla P, Długopolski R, Krupa E. , et al. Electrocardiography and prognosis of patients with acute pulmonary embolism. Cardiol J 2011; 18 (06) 648-653
  • 50 Moutzouris JP, Ng AC, Chow V, Chung T, Curnow J, Kritharides L. Acute pulmonary embolism during warfarin therapy and long-term risk of recurrent fatal pulmonary embolism. Thromb Haemost 2013; 110 (03) 523-533
  • 51 Otero R, Elías T, Jara L. , et al; RIETE investigators. Factors associated with elevated pulmonary arterial pressure levels on the echocardiographic assessment in patients with prior pulmonary embolism. Thromb Res 2013; 131 (05) e191-e195
  • 52 Stein PD, Matta F, Sabra MJ. , et al. Relation of electrocardiographic changes in pulmonary embolism to right ventricular enlargement. Am J Cardiol 2013; 112 (12) 1958-1961
  • 53 Barra SN, Paiva LV, Providência R, Fernandes A, Leitão Marques A. Atrial fibrillation in acute pulmonary embolism: prognostic considerations. Emerg Med J 2014; 31 (04) 308-312
  • 54 Keller K, Prochaska JH, Coldewey M. , et al. History of deep vein thrombosis is a discriminator for concomitant atrial fibrillation in pulmonary embolism. Thromb Res 2015; 136 (05) 899-906
  • 55 Bajaj N, Bozarth AL, Guillot J. , et al. Clinical features in patients with pulmonary embolism at a community hospital: analysis of 4 years of data. J Thromb Thrombolysis 2014; 37 (03) 287-292
  • 56 Ng AC, Adikari D, Yuan D. , et al. The prevalence and incidence of atrial fibrillation in patients with acute pulmonary embolism. PLoS One 2016; 11 (03) e0150448
  • 57 Short DS. A survey of pulmonary embolism in a general hospital. BMJ 1952; 1 (4762): 790-796
  • 58 Sallach JA, Sallach SM, Thomas JD, Garcia MJ, Hudson MP, McCord JK. Prognostic value of electrocardiographic abnormalities in patients with acute pulmonary embolism. Chest 2003; 124 (04) 239S
  • 59 Kukla P, McIntyre WF, Fijorek K. , et al. Electrocardiographic abnormalities in patients with acute pulmonary embolism complicated by cardiogenic shock. Am J Emerg Med 2014; 32 (06) 507-510
  • 60 Karlen WS, Wolff L. The vectorcardiogram in pulmonary embolism. II. Am Heart J 1956; 51 (06) 839-860
  • 61 Weber DM, Phillips Jr JH. A re-evaluation of electrocardiographic changes accompanying acute pulmonary embolism. Am J Med Sci 1966; 251 (04) 381-398
  • 62 Stein PD, Dalen JE, McIntyre KM, Sasahara AA, Wenger NK, Willis III PW. The electrocardiogram in acute pulmonary embolism. Prog Cardiovasc Dis 1975; 17 (04) 247-257
  • 63 Costantini M, Bossone E, Renna R. , et al. Electrocardiographic features in critical pulmonary embolism. Results from baseline and continuous electrocardiographic monitoring. Ital Heart J 2004; 5 (03) 214-216
  • 64 Prandoni P, Pesavento R, Sørensen HT. , et al. Prevalence of heart diseases in patients with pulmonary embolism with and without peripheral venous thrombosis: findings from a cross-sectional survey. Eur J Intern Med 2009; 20 (05) 470-473
  • 65 Chakko S, Richards III F. Right-sided cardiac thrombi and pulmonary embolism. Am J Cardiol 1987; 59 (01) 195-196
  • 66 Hald EM, Enga KF, Løchen ML. , et al. Venous thromboembolism increases the risk of atrial fibrillation: the Tromso study. J Am Heart Assoc 2014; 3 (01) e000483
  • 67 Sasahara AA, Hyers TM, Cole CM. , et al. The urokinase-pulmonary embolism trial. A national cooperative study. Circulation 1973; 48 (02) 60-65
  • 68 Pollack CV, Schreiber D, Goldhaber SZ. , et al. Clinical characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department: initial report of EMPEROR (Multicenter Emergency Medicine Pulmonary Embolism in the Real World Registry). J Am Coll Cardiol 2011; 57 (06) 700-706
  • 69 Agnelli G, Verso M, Ageno W. , et al; MASTER investigators. The MASTER registry on venous thromboembolism: description of the study cohort. Thromb Res 2008; 121 (05) 605-610
  • 70 Stein PD, Henry JW. Clinical characteristics of patients with acute pulmonary embolism stratified according to their presenting syndromes. Chest 1997; 112 (04) 974-979
  • 71 Casazza F, Becattini C, Bongarzoni A. , et al. Clinical features and short term outcomes of patients with acute pulmonary embolism. The Italian Pulmonary Embolism Registry (IPER). Thromb Res 2012; 130 (06) 847-852
  • 72 Mc Ginn S, White PD. Acute cor pulmonale resulting from pulmonary embolism. Its clinical recognition. JAMA 1935; 104: 1473-1478
  • 73 Jordan RA, Scheifley CH, Edwards JE. Mural thrombosis and arterial embolism in mitral stenosis; a clinico-pathologic study of fifty-one cases. Circulation 1951; 3 (03) 363-367
  • 74 Hurst JW, Paulk Jr EA, Proctor HD, Schlant RC. Management of patients with atrial fibrillation. Am J Med 1964; 37: 728-741
  • 75 Oram S, Davies JP. Further experience of electrical conversion of atrial fibrillation to sinus rhythm: analysis of 100 patients. Lancet 1964; 1 (7346): 1294-1298
  • 76 Aberg H. Atrial fibrillation. I. A study of atrial thrombosis and systemic embolism in a necropsy material. Acta Med Scand 1969; 185 (05) 373-379
  • 77 Noel P, Gregoire F, Capon A, Lehert P. Atrial fibrillation as a risk factor for deep venous thrombosis and pulmonary emboli in stroke patients. Stroke 1991; 22 (06) 760-762
  • 78 Piszko P, Lewczuk J, Lenartowska L. , et al. Pulmonary thromboembolism in 102 consecutive patients with chronic atrial fibrillation. Diagnostic value of echocardiography. Kardiol Pol 2007; 65 (03) 246-251 , discussion 252–253
  • 79 Yasuoka Y, Naito J, Hirooka K. , et al. Right atrial spontaneous echo contrast indicates a high incidence of perfusion defects in pulmonary scintigraphy in patients with atrial fibrillation. Heart Vessels 2009; 24 (01) 32-36
  • 80 Gex G, Gerstel E, Righini M. , et al. Is atrial fibrillation associated with pulmonary embolism?. J Thromb Haemost 2012; 10 (03) 347-351
  • 81 Saliba W, Rennert G. CHA2DS2-VASc score is directly associated with the risk of pulmonary embolism in patients with atrial fibrillation. Am J Med 2014; 127 (01) 45-52
  • 82 Wang CC, Lin CL, Wang GJ, Chang CT, Sung FC, Kao CH. Atrial fibrillation associated with increased risk of venous thromboembolism. A population-based cohort study. Thromb Haemost 2015; 113 (01) 185-192
  • 83 Lip GY, Gitt AK, Le Heuzey JY. , et al; RHYTHM-AF Scientific Committee. Overtreatment and undertreatment with anticoagulation in relation to cardioversion of atrial fibrillation (the RHYTHM-AF study). Am J Cardiol 2014; 113 (03) 480-484
  • 84 Basili S, Proietti M, Perticone F, Corazza GR, Violi F. ; ARAPACIS Study Investigators. Atrial fibrillation is not associated with increased risk of venous thromboembolism: Results from ARAPACIS study. Thromb Haemost 2015; 114 (03) 655
  • 85 Enga KF, Rye-Holmboe I, Hald EM. , et al. Atrial fibrillation and future risk of venous thromboembolism: the Tromsø study. J Thromb Haemost 2015; 13 (01) 10-16
  • 86 Hsu JC, Chan PS, Tang F, Maddox TM, Marcus GM. Oral anticoagulant prescription in patients with atrial fibrillation and a low risk of thromboembolism: insights from the NCDR PINNACLE registry. JAMA Intern Med 2015; 175 (06) 1062-1065
  • 87 Huisman MV, Lip GY, Diener HC. , et al. Design and rationale of Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation: a global registry program on long-term oral antithrombotic treatment in patients with atrial fibrillation. Am Heart J 2014; 167 (03) 329-334
  • 88 Kakkar AK, Mueller I, Bassand JP. , et al; GARFIELD Registry Investigators. Risk profiles and antithrombotic treatment of patients newly diagnosed with atrial fibrillation at risk of stroke: perspectives from the international, observational, prospective GARFIELD registry. PLoS One 2013; 8 (05) e63479
  • 89 Lip GY, Laroche C, Ioachim PM. , et al. Prognosis and treatment of atrial fibrillation patients by European cardiologists: one year follow-up of the EURObservational Research Programme-Atrial Fibrillation General Registry Pilot Phase (EORP-AF Pilot registry). Eur Heart J 2014; 35 (47) 3365-3376
  • 90 Goldhaber SZ, Grodstein F, Stampfer MJ. , et al. A prospective study of risk factors for pulmonary embolism in women. JAMA 1997; 277 (08) 642-645
  • 91 Chung WS, Lin CL, Kao CH. Diabetes increases the risk of deep-vein thrombosis and pulmonary embolism. A population-based cohort study. Thromb Haemost 2015; 114 (04) 812-818
  • 92 Onuk T, Karataş MB, İpek G. , et al. Higher CHA2DS2-VASc score is associated with increased mortality in acute pulmonary embolism. Clin Appl Thromb Hemost 2016;
  • 93 Koracevic G, Atanaskovic V. Is atrial fibrillation a prognosticator in acute pulmonary thromboembolism?. Med Princ Pract 2010; 19 (02) 166
  • 94 Geibel A, Zehender M, Kasper W, Olschewski M, Klima C, Konstantinides SV. Prognostic value of the ECG on admission in patients with acute major pulmonary embolism. Eur Respir J 2005; 25 (05) 843-848
  • 95 Escobar C, Jiménez D, Martí D. , et al. Prognostic value of electrocardiographic findings in hemodynamically stable patients with acute symptomatic pulmonary embolism [in Spanish]. Rev Esp Cardiol 2008; 61 (03) 244-250
  • 96 Shopp JD, Stewart LK, Emmett TW, Kline JA. Findings from 12-lead electrocardiography that predict circulatory shock from pulmonary embolism: systematic review and meta-analysis. Acad Emerg Med 2015; 22 (10) 1127-1137
  • 97 Ridker PM, Goldhaber SZ, Danielson E. , et al; PREVENT Investigators. Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism. N Engl J Med 2003; 348 (15) 1425-1434
  • 98 Goldhaber SZ. Low intensity warfarin anticoagulation is safe and effective as a long-term venous thromboembolism prevention strategy. J Thromb Thrombolysis 2006; 21 (01) 51-52
  • 99 Kearon C, Ginsberg JS, Kovacs MJ. , et al; Extended Low-Intensity Anticoagulation for Thrombo-Embolism Investigators. Comparison of low-intensity warfarin therapy with conventional-intensity warfarin therapy for long-term prevention of recurrent venous thromboembolism. N Engl J Med 2003; 349 (07) 631-639
  • 100 Kearon C, Akl EA, Ornelas J. , et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 2016; 149 (02) 315-352
  • 101 January CT, Wann LS, Alpert JS. , et al; ACC/AHA Task Force Members. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation 2014; 130 (23) e199-e267
  • 102 You JJ, Singer DE, Howard PA. , et al. American College of Chest P. Antithrombotic therapy for atrial fibrillation: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141: e531S-e575S
  • 103 Camm AJ, Lip GY, De Caterina R. , et al; ESC Committee for Practice Guidelines (CPG). 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 2012; 33 (21) 2719-2747
  • 104 Konstantinides SV, Torbicki A, Agnelli G. , et al; Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014; 35 (43) 3033-3069 , 3069a–3069k
  • 105 Smith Jr SC, Benjamin EJ, Bonow RO. , et al; World Heart Federation and the Preventive Cardiovascular Nurses Association. AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation 2011; 124 (22) 2458-2473