Atrial fibrillation resident survival guide
Conduction | ||
Sinus rhythm | Atrial fibrillation |
Atrial Fibrillation Microchapters | |
Special Groups | |
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Diagnosis | |
Treatment | |
Cardioversion | |
Anticoagulation | |
Surgery | |
Case Studies | |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Definition
Atrial fibrillation (AF or Afib) is a cardiac arrhythmia (abnormal heart rhythm) that involves the two upper chambers (atria) of the heart.
Causes
Life Threatening Causes
Atrial fibrillation is a life-threatening condition and must be treated as such irrespective of the causes. Life-threatening conditions can result in death or permanent disability within 24 hours if left untreated.
Common Causes
Management
Figure 1: Pharmacological management of patients with newly discovered atrial fibrillation:[1]
Newly discovered AF | |||||||||||||||||||||||||||||||||||||
Paroxysmal | Persistent | ||||||||||||||||||||||||||||||||||||
No therapy needed unless severe symptoms (e.g., hypotension, HF, angina pectoris | Accept permanent AF | Rate control and anticoagulation as needed | |||||||||||||||||||||||||||||||||||
Anticoagulation as needed | Anticoagulaion and rate control* as needed | Consider antiarrhythmic drug therapy | |||||||||||||||||||||||||||||||||||
Cardioversion | |||||||||||||||||||||||||||||||||||||
Long term antiarrhythmic drug therapy unnecessary | |||||||||||||||||||||||||||||||||||||
ADD indicates antiarrhythmic drugs
*See figure 5
Figure 2: Pharmacological management of patients with recurrent paroxysmal atrial fibrillation:[1]
Recurrent paroxysmal AF | |||||||||||||||||||||||||||||||||
Minimal or no symptoms | Disabling symptoms in AF | ||||||||||||||||||||||||||||||||
Anticoagulation and rate control as needed | Anticoagulation and rate control as needed | ||||||||||||||||||||||||||||||||
No drug for prevention of AF | Antiarrhythmic drug therapy* | ||||||||||||||||||||||||||||||||
AF ablation if ADD* treatment fails | |||||||||||||||||||||||||||||||||
ADD indicates antiarrhythmic drugs
*See figure 5
Figure 3: Pharmacological management of patients with recurrent persistent atrial fibrillation:[1]
Recurrent persistent AF | |||||||||||||||||||||||||||||||||
Minimal or no symptoms | Disabling symptoms in AF | ||||||||||||||||||||||||||||||||
Anticoagulation and rate control as needed | Anticoagulation and rate control | ||||||||||||||||||||||||||||||||
Antiarrhythmic drug therapy* | |||||||||||||||||||||||||||||||||
Electrical cardioversion as needed | |||||||||||||||||||||||||||||||||
Continue anticoagulation as needed and therapy to maintain sinus rhythm* | |||||||||||||||||||||||||||||||||
Consider ablation for severely symptomatic recurrent AF after failure of greater than or equal to 1 ADD* plus rate control | |||||||||||||||||||||||||||||||||
ADD indicates antiarrhythmic drugs
*See figure 5. Initiate drug therapy before cardioversion to reduce the likelihood of early recurrence of AF.
Figure 4: Pharmacological management of patients with permanent atrial fibrillation:[1]
Permanent AF | |||||||||||||||||||||||||||||||
Anticoagulation and rate control* as needed | |||||||||||||||||||||||||||||||
*See figure 5
Figure 5: Antiarrhythmic drug therapy for maintain sinus rhythm in patients with recurrent paroxysmal or persistent atrial fibrillation:[1]
Drugs are listed alphabetically and not in order of suggested use.
The seriousness of heart disease progresses from left to right, and selection of therapy in patients with multiple conditions depends on the most serious condition present.
LVH indicates left ventricular hypertrophy.
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Fuster, V.; Rydén, LE.; Cannom, DS.; Crijns, HJ.; Curtis, AB.; Ellenbogen, KA.; Halperin, JL.; Kay, GN.; Le Huezey, JY. (2011). "2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines". Circulation. 123 (10): e269–367. doi:10.1161/CIR.0b013e318214876d. PMID 21382897. Unknown parameter
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