II. Precautions
-
Atrial Fibrillation Rate Control has historically been preferred for most patients due to Antiarrhythmics adverse events
- However rhythm control is better at reducing symptoms, and improves ventricular function
- Rhythm control also reduces stroke risk and mortality in first year
- Carlsson (2003) J Am Coll Cardiol 41(10): 1690-6 [PubMed]
- Newer studies compared rate control to catheter ablation
- Catheter ablation appears superior to rate control in comorbid Heart Failure
- Marrouche (2018) N Engl J Med 378:417-27 [PubMed]
- Catheter ablation instead of Antiarrhythmic drugs is associated with lower Atrial Fib recurrence, and lower complications rates
- Rhythm control may be preferred in high risk cardiovascular patients in Atrial Fibrillation <1 year
- NNT 91 to prevent one cardiovascular death, hospitalization or Cerebrovascular Accident in 5 years
- But rhythm control is associated with serious complications in 2% of patients
- Camm (2022) J Am Coll Cardiol 79(19): 1932-48 [PubMed]
- Kirchhof (2020) N Engl J Med 383(14): 1305-16 [PubMed]
III. Indications: Chronic Atrial Fibrillation
- Symptomatic patients
- Younger patients (esp. <65 years old)
- Poor rate control with recurrent hospitalizations
- Lone Atrial Fibrillation with initial presentation
- Precipitating factor has been corrected or controlled
IV. Management
- Intermittent paroxysmal Atrial Fibrillation
- Chronic rhythm control is combined with rate control and Anticoagulation
- Rhythm Control Agent Selection
- See Atrial Fibrillation Pharmacologic Cardioversion (reviews the Antiarrhythmic agents as they apply to cardioversion)
- Better tolerated agents (but contraindicated in CHF, structural heart disease, CAD)
- Agents with fewer contraindications (may be used in CHF, CAD), but with increased adverse effects
V. References
- (2023) Presc Lett 30(2): 9-10
Images: Related links to external sites (from Bing)
Related Studies
| Definition (CHV) | rapid tremor and shake of upper chambers of the heart |
| Definition (CHV) | rapid tremor and shake of upper chambers of the heart |
| Definition (CHV) | rapid tremor and shake of upper chambers of the heart |
| Definition (CHV) | rapid tremor and shake of upper chambers of the heart |
| Definition (CHV) | rapid tremor and shake of upper chambers of the heart |
| Definition (CHV) | rapid tremor and shake of upper chambers of the heart |
| Definition (MEDLINEPLUS) |
An arrhythmia is a problem with the speed or rhythm of the heartbeat. Atrial fibrillation (AF) is the most common type of arrhythmia. The cause is a disorder in the heart's electrical system. Often, people who have AF may not even feel symptoms. But you may feel
AF can lead to an increased risk of stroke. In many patients, it can also cause chest pain, heart attack, or heart failure. Doctors diagnose AF using family and medical history, a physical exam, and a test called an electrocardiogram (EKG), which looks at the electrical waves your heart makes. Treatments include medicines and procedures to restore normal rhythm. NIH: National Heart, Lung, and Blood Institute |
| Definition (NCI_CTCAE) | A disorder characterized by a dysrhythmia without discernible P waves and an irregular ventricular response due to multiple reentry circuits. The rhythm disturbance originates above the ventricles. |
| Definition (NCI_FDA) | 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 disorder characterized by an electrocardiographic finding of a supraventricular arrhythmia characterized by the replacement of consistent P waves by rapid oscillations or fibrillatory waves that vary in size, shape and timing and are accompanied by an irregular ventricular response. (CDISC) |
| Definition (CSP) | disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. |
| 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. |
| Concepts | Pathologic Function (T046) |
| MSH | D001281 |
| ICD9 | 427.31 |
| SnomedCT | 155364009, 266306001, 49436004 |
| LNC | LA17084-7 |
| English | Atrial Fibrillations, Auricular Fibrillation, Auricular Fibrillations, Fibrillations, Atrial, Fibrillations, Auricular, FIBRILLATION ATRIAL, AURICULAR FIBRILLATION, Auricular fibrillation, Fibrillation, Atrial, Fibrillation, Auricular, AF, atrial fibrillation, atrial fibrillation (diagnosis), Afib, AFib, Fibrillation atrial, Atrial Fibrillation [Disease/Finding], Fibrillation;atrial, afib, atrial fibrillation (AF), auricular fibrillations, atrial fibrillations, Familial Atrial Fibrillation, Fibrillation - atrial, ATRIAL FIBRILLATION, Atrial fibrillation, AF - Atrial fibrillation, Atrial fibrillation (disorder), atrium; fibrillation, auricular; fibrillation, fibrillation; atrial or auricular, Atrial Fibrillation, auricular fibrillation |
| French | FIBRILLATION AURICULAIRE, FA, AFib, Fibrillation auriculaire, Fibrillation atriale |
| German | VORHOFFLIMMERN, AF, Afib, Flimmern Vorhof, Herzohrflimmern, HERZVORHOFFLIMMERN, Vorhofflimmern, Aurikuläres Flimmern |
| Portuguese | FIBRILACAO AURICULAR, FA, FIBRILHACAO AURICULAR, Fibrilhação auricular, Fibrilação Atrial, Fibrilação Auricular |
| Spanish | FIBRILACION AURICULAR, FA, Fibrilación atrial, AURICULAR, FIBRILACION, fibrilación auricular (trastorno), fibrilación auricular, Fibrilación auricular, Fibrilación Atrial, Fibrilación Auricular |
| Dutch | AFib, AF, atriumfibrillatie, hartoorfibrilleren, atrium; fibrilleren, auriculair; fibrilleren, fibrilleren; atrium of auriculair, atriale fibrillatie, Atriumfibrillatie, Boezemfibrillatie, Fibrillatie, atrium-, Fibrillatie, boezem-, Fibrilleren, boezem- |
| Swedish | Förmaksflimmer |
| Japanese | ｼﾝﾎﾞｳｻｲﾄﾞｳ, 心房細動, 心房性細動 |
| Finnish | Eteisvärinä |
| Russian | USHKA PREDSERDIIA FIBRILLIATSIIA, PREDSERDII FIBRILLIATSIIA, ПРЕДСЕРДИЙ ФИБРИЛЛЯЦИЯ, УШКА ПРЕДСЕРДИЯ ФИБРИЛЛЯЦИЯ |
| Czech | Fibrilace ouška, Fibrilace síní, fibrilace síní, síňová fibrilace, FiS |
| Italian | Fibrillazione auricolare, Fibrillazione atriale |
| Croatian | ATRIJ, FIBRILACIJA |
| Polish | Migotanie przedsionków |
| Hungarian | AFib, Fibrillatio atrialis, Pitvarfibrillatio |
| Norwegian | Forkammerflimmer, Hjerteflimmer, Artrieflimmer |
