Atrial fibrillation primary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2] Cafer Zorkun, M.D., Ph.D. [3] Laith Adnan Allaham, M.D.[4]
Overview
Although no certain primary prevention has been introduced for atrial fibrillation (AF), some medications may prevent the atrial fibrillation development in specific patients. Amiodarone, a beta blocker, or a Calcium-channel blocker may be helpful to prevent atrial fibrillation in patients who undergone cardiac surgery. Moreover, treatment with ACE inhibitor or ARB may lower the chance of atrial fibrillation development in hypertensive patients.
Atrial Fibrillation Primary Prevention
Preventing Postoperative Atrial Fibrillation
- One of the following could be offered to prevent atrial fibrillation development in patients who have been undergone cardiac surgery:[1]
- Amiodarone
- Beta blocker (a standard beta blocker is suggested)
- Calcium-channel blockers such as diltiazem or verapamil
- In patients who have been undergone cardiac surgery and were on a beta blocker before the surgery, continuing the treatment in the absence of any complications (such as postoperative bradycardia or hypotension) is recommended.
- Offering digoxin in patients who have been undergone cardiac surgery in order to prevent atrial fibrillation should be avoided.[1]
- Do not use statins for the purpose of atrial fibrillation prevention in patients who have been undergone cardiac surgery. Nevertheless continuing statins in patients who had been on statins before the surgery is recommended.[1]
- Treatment with ACE inhibitor or ARB may lower the chance of atrial fibrillation development in hypertensive patients.[2]
2019 AHA/ACC/HRS Focused Update of the 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 Clinical Practice Guidelines and the Heart Rhythm Society[3]
Recommendation for Weight Loss in Patients with AF Referenced studies that support the new recommendation are summarized in Online Data Supplement 10
| Class I |
| 1. For overweight and obese patients with AF, weight loss, combined with risk factor modification, is recommended.S7.13-1–S7.13-3NEW: New data demonstrate the beneficial effects of weight loss and risk factor modification on controlling AF(Level of Evidence: B-R) |
2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)[2]
Rhythm Control
Pharmacological Agents for Preventing AF and Maintaining Sinus Rhythm
Upstream Therapy
| Class III: No Benefit |
| "1. Therapy with an ACE inhibitor, ARB, or statin is not beneficial for primary prevention of AF in patients without cardiovascular disease. (Level of Evidence: B)" |
| Class IIa |
| "1. An ACE inhibitor or angiotensin-receptor blocker (ARB) is reasonable for primary prevention of new-onset AF in patients with HF with reduced LVEF. (Level of Evidence: B)" |
| Class IIb |
| "1. Therapy with an ACE inhibitor or ARB may be considered for primary prevention of new-onset AF in the setting of hypertension. (Level of Evidence: B)" |
| "2. Statin therapy may be reasonable for primary prevention of new-onset AF after coronary artery surgery. (Level of Evidence: A)" |
Sources
References
- ↑ 1.0 1.1 1.2 Perry M, Kemmis Betty S, Downes N, Andrews N, Mackenzie S, Guideline Committee (2021). "Atrial fibrillation: diagnosis and management-summary of NICE guidance". BMJ. 373: n1150. doi:10.1136/bmj.n1150. PMID 34020968 Check
|pmid=value (help). - ↑ 2.0 2.1 2.2 January, C. T.; Wann, L. S.; Alpert, J. S.; Calkins, H.; Cleveland, J. C.; Cigarroa, J. E.; Conti, J. B.; Ellinor, P. T.; Ezekowitz, M. D.; Field, M. E.; Murray, K. T.; Sacco, R. L.; Stevenson, W. G.; Tchou, P. J.; Tracy, C. M.; Yancy, C. W. (2014). "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. doi:10.1161/CIR.0000000000000041. ISSN 0009-7322.
- ↑ January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC; et al. (2019). "2019 AHA/ACC/HRS Focused Update of the 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 Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons". Circulation. 140 (2): e125–e151. doi:10.1161/CIR.0000000000000665. PMID 30686041.