Atrial fibrillation resident survival guide
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Sinus rhythm  |
Atrial fibrillation  | |
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Atrial Fibrillation Microchapters | |
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Special Groups | |
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Diagnosis | |
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Treatment | |
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Cardioversion | |
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Anticoagulation | |
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Surgery | |
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Case Studies | |
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Atrial fibrillation resident survival guide On the Web | |
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Directions to Hospitals Treating Atrial fibrillation resident survival guide | |
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Risk calculators and risk factors for Atrial fibrillation resident survival guide | |
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
Common Causes
- COPD
- Coronary heart disease
- Drugs
- Hypertension
- Hypertensive heart disease
- MI
- Rheumatic heart disease
- Sick sinus syndrome
- Sleep apnea
- Stress
- Thyrotoxicosis
- Valvular heart disease
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. 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
References
- ↑ 1.0 1.1 1.2 1.3 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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