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Atrial Fibrillation Rate Control

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  1. See Also
    1. Guidelines 2000 CPR and Emergency Cardiovascular Care
    2. Atrial Fibrillation
    3. Atrial Fibrillation Acute Management
    4. Atrial Fibrillation Anticoagulation
    5. Atrial Fibrillation Cardioversion
  2. Indications
    1. Atrial Fibrillation with rapid ventricular rate
  3. Precautions
    1. Beware agents which may cardiovert Atrial Fib >48 hours
      1. Risk of embolic complications
  4. Target Heart Rate
    1. Heart Rate: 70-90 bpm
  5. Rate Control: WPW Syndrome with preserved heart function
    1. General
      1. Risk of embolus if rhythm cardioverts
      2. Consider Atrial Fibrillation Anticoagulation
    2. Avoid Harmful agents
      1. Adenosine
      2. Beta Blocker
      3. Calcium Channel Blocker
      4. Digoxin
    3. Recommended agents (Use only 1 agent)
      1. Electrical Synchronized Cardioversion if unstable
      2. Class IA Agents
        1. Procainamide
      3. Class IC Agents
        1. Propafenone (Rythmol)
        2. Flecainide (Tambocor)
      4. Class III Agents
        1. Amiodarone (Cordarone)
        2. Sotalol (Betapace)
  6. Rate control: WPW with Ejection Fraction <40%
    1. General
      1. Risk of embolus if rhythm cardioverts
      2. Consider Atrial Fibrillation Anticoagulation
    2. Recommended agents
      1. Electrical Synchronized Cardioversion
      2. Amiodarone (Cordarone)
  7. Rate control: Heart function preserved (No WPW)
    1. General
      1. Risk of embolus if rhythm cardioverts
      2. Consider Atrial Fibrillation Anticoagulation
    2. Recommended agents
      1. Beta Blockers
        1. Propranolol (Inderal)
        2. Esmolol (Brevibloc)
        3. Metoprolol (Lopressor)
      2. Calcium Channel Blocker
        1. Verapamil (Calan)
        2. Diltiazem (Cardizem) - preferred
          1. See Diltiazem for dosing protocol
  8. Rate control: Ejection Fraction <40% (No WPW)
    1. General
      1. Risk of embolus if rhythm cardioverts
      2. Consider Atrial Fibrillation Anticoagulation
    2. Recommended agents
      1. Digoxin (Lanoxin)
      2. Diltiazem (Cardizem) - preferred
      3. Amiodarone
  9. Choosing longterm rate versus rhythm control
    1. Rate control has less drug-related adverse effects
    2. Rate control has equivalent efficacy to rhythm control
      1. Same survival benefit
      2. Same Cerebrovascular Accident risk
    3. Rhythm control may offer benefit in age <65 years
    4. References
      1. Wyse (2002) N Engl J Med 347:1825
  10. References
    1. Dell'Orfano (1998) Am Fam Physician 58(2):471
    2. Hebbar (2002) Am Fam Physician 65(12):2479
    3. King (2002) Am Fam Physician 66:249
    4. (2000) Circulation, 102(Suppl I):86-9
    5. http://www.circulationaha.org

Atrial Fibrillation (C0004238)

Definition (MSH)Abnormal cardiac rhythm that is characterized by rapid, uncoordinated firing of electrical impulses in the upper chambers of the heart (HEART ATRIA). In such case, blood cannot be effectively pumped into the lower chambers of the heart (HEART VENTRICLES). It is caused by abnormal impulse generation.
Definition (CSP)disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions.
Definition (NCI)An arrhythmia in which minute areas of the atrial myocardium are in various uncoordinated stages of depolarization and repolarization; instead of intermittently contracting, the atria quiver continuously in a chaotic pattern, causing a totally irregular, often rapid ventricular rate.
Definition (NCI)A supraventricular arrhythmia characterized by uncoordinated atrial myocardium activation due to multiple reentry circuits with consequent deterioration of atrial mechanical function. Instead of intermittently contracting, the atria quiver continuously in a chaotic pattern, causing a totally irregular, often tachycardia ventricular rate. On the ECG it is described by the replacement of consistent P waves by rapid oscillations or fibrillatory waves that vary in size, shape, and timing, associated with an irregular, frequently rapid ventricular response when atrioventricular conduction is intact.
ConceptsPathologic Function (T046)
ICD9427.31
MSHD001281
EnglishAF, AF - Atrial fibrillation, AFib, Atrial Fibrillation, Atrial Fibrillations, Auricular Fibrillation, Auricular Fibrillations, Fibrillation - atrial, FIBRILLATION ATRIAL
Spanishfibrilacion auricular
Parent ConceptsFibrillation (C0232197), cardiac arrhythmia (C0003811), Atrial fibrillation and flutter NOS (C0155709), Supraventricular arrhythmia (C0428974), Atrial arrhythmia (C0085611)
SourcesAOD, CCS, COSTAR, CSP, CST, DXP, ICD9CM, LCH, MEDLINEPLUS, MSH, MTH, NCI, NDFRT, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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