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Treatment Overview in Atrial Fibrillation

Treatment Overview in Atrial Fibrillation. Suneeta Acharya , M4. Objectives. Define atrial fibrillation Describe complications from disease Outline clinical manifestations of AF Discuss treatment options. Atrial Fibrillation- The Basics. Most common cardiac arrhytmia

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Treatment Overview in Atrial Fibrillation

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  1. Treatment Overview in Atrial Fibrillation SuneetaAcharya, M4

  2. Objectives • Define atrial fibrillation • Describe complications from disease • Outline clinical manifestations of AF • Discuss treatment options

  3. Atrial Fibrillation- The Basics • Most common cardiac arrhytmia • RR intervals without repetitive pattern • Types: • Paroxysmal – Recurrent AF that terminates in 7 days or less • Persistent – AF that does not terminate within 7 days

  4. Complications • Tachycardia-mediated cardiomyopathy: • Decrease in cardiac output, i.e., cardiac failure • Atrial thrombus formation • Can embolize, causing strokes, arterial/venous occlusions • Most symptoms experienced are due to rapid ventricular response

  5. Clinical Manifestation • Typical: • Palpitations, tachycardia, fatigue, weakness, dizziness, lightheadedness, reduced exercise capacity, or mild dyspnea • Severe symptoms • Dyspnea at rest, angina, presyncope, or syncope • Embolic event • Right-sided heart failure

  6. Treatment • Acute AF episode • Goal: Achieve sinus rhythm and reduce risk of embolization

  7. Tx: Cardioversion • Candidates • Hemodynamically unstable patients • First episode of AF • Infrequent, non-spontaneously resolving AF • Worsening symptoms of AF • Types: • Direct current: for patients with severe left heart failure, ongoing MI, or hypotension • Pharmacological: various antiarrhythmics (flecainide, amiodarone)

  8. Rate Control-Acute • Control ventricular rate in AF with RVR • Hemodynamically stable: • Nondihydropyridine calcium channel blockers • Diltiazem • Verapamil • Unstable: • Digoxin • Amiodarone • Goal: revert to sinus rhythm!

  9. Rate Control- Chronic • Oral Beta blocker • Metoprolol, atenolol, labetalol • Oral Calcium channel blocker • Verapamil, diltiazem

  10. Anticoagulation • Acute treatment: • Warfarin if cardioversion may be necessary • Chronic therapy: • CHADS-2 > 0 • Check INR • Newer therapies don’t require INR checks

  11. 60 y/o white male with no past medical history presents to E.D. complaining of mild dyspnea, palpitations, and lightheadedness that began 4 hours ago.  Patient has had similar symptoms in the past for which he was seen in an E.D. in another state.  Patient was prescribed a medication at the time, but he did not have the prescription filled because the symptoms abated within 4 days.  Physical examination and vital signs include tachycardia to 150 and an irregularly irregular rhythm heard on auscultation. Diagnosed with atrial fibrillation with mild-moderate symptoms. Rate control is achieved with i.v. diltiazem.What is the most appropriate long-term therapy for this patient’s condition? • A. Aspirin 81 mg • B. Hydrochlorothiazide • C. Metoprolol • D. Warfarin

  12. References • UpToDate

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