How would you treat a patient with atrial fibrillation ?
Attempt to restore slow ventricular rate:
• In the hypertensive patient use calcium antagonists (verapamil, diltiazem).
• In thyroid disease use a beta-blocker (e.g. propranolol).
• In ischaemic heart disease use a beta-blocker or diltiazem, verapamil.
• In heart failure use digoxin or verapamil.
• In hypertrophic cardiomyopathy use a beta-blocker or calcium antagonists.
• In those who are intolerant of or do not respond to drugs, radiofrequency catheter ablation of the
atrioventricular node (with a cardiac pacemaker) may provide symptomatic relief; however, it does not
change the risk of systemic emboli or the need for anticoagulation (N Engl J Med 1999; 340: 534).
• More recently, radiofrequency ablation of the pulmonary veins has been shown to be effective in
paroxysmal atrial fibrillation when the ectopic focus is in the pulmonary veins.
Attempt to restore sinus rhythm by cardioversion if the following conditions apply:
• Left atrial size by echocardiogram is less than 4.5 cm (left atrial size >4.5 cm is not associated with
long-term maintenance of sinus rhythm).
• Short duration of the arrhythmia (acute atrial fibrillation is likely to remain in sinus rhythm).
• Drugs used to restore sinus rhythm or prevent recurrence include quinidine, procainamide,
disopyramide, propafenone, sotalol, fiecainide, amiodarone and ibutilide (N Engl J Med 2000;
342:913-20; Circulation 1996; 94:1613).
Anticoagulation with warfarin is advised for certain patients':
• Undergoing cardioversion (electrical or drug).
• With underlying mitral valve disease.
• In left ventricular failure.
• With cardiomyopathy.
• Above the age of 60 years.
Lexo edhe:
Attempt to restore slow ventricular rate:
• In the hypertensive patient use calcium antagonists (verapamil, diltiazem).
• In thyroid disease use a beta-blocker (e.g. propranolol).
• In ischaemic heart disease use a beta-blocker or diltiazem, verapamil.
• In heart failure use digoxin or verapamil.
• In hypertrophic cardiomyopathy use a beta-blocker or calcium antagonists.
• In those who are intolerant of or do not respond to drugs, radiofrequency catheter ablation of the
atrioventricular node (with a cardiac pacemaker) may provide symptomatic relief; however, it does not
change the risk of systemic emboli or the need for anticoagulation (N Engl J Med 1999; 340: 534).
• More recently, radiofrequency ablation of the pulmonary veins has been shown to be effective in
paroxysmal atrial fibrillation when the ectopic focus is in the pulmonary veins.
Attempt to restore sinus rhythm by cardioversion if the following conditions apply:
• Left atrial size by echocardiogram is less than 4.5 cm (left atrial size >4.5 cm is not associated with
long-term maintenance of sinus rhythm).
• Short duration of the arrhythmia (acute atrial fibrillation is likely to remain in sinus rhythm).
• Drugs used to restore sinus rhythm or prevent recurrence include quinidine, procainamide,
disopyramide, propafenone, sotalol, fiecainide, amiodarone and ibutilide (N Engl J Med 2000;
342:913-20; Circulation 1996; 94:1613).
Anticoagulation with warfarin is advised for certain patients':
• Undergoing cardioversion (electrical or drug).
• With underlying mitral valve disease.
• In left ventricular failure.
• With cardiomyopathy.
• Above the age of 60 years.
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Lexo edhe:
