Treatment Options for atrial fibrillation:
- Electrical Cardioversion-
- patients that are hemodynamically unstable (low blood pressure or heart rate) and need immediate rate control.
- Patients with persistent afib (must be anticoagulated with coumadin for 4 weeks before cardioversion to prevent an embolus from traveling to the brain and causing a stroke).
- Pharmacologic Cardioversion with Anti-arrhythmic medications (amiodarone, dofetilide, ibutilide, propafenone, flecainide):
- Patients with recurrent paroxysmal or persistent atrial fibrillation
- Rate control and anticoagulation
- Rate control- beat blockers, calcium channel blockers, occasionally digoxin used alone or in combination.
- Anticoagulation- coumadin. Use CHADS2 score described earlier to determine who needs coumadin.
- Catheter ablation
- Surgical ablation
*2 trials compared the results of rate control and anticoagulation (treatment option 3 above) with normal sinus rhythm control (treatment option 2 above) and found that there was no higher rate of death or stroke in the rate control than the anticoagulation group.
*Elective cardioversion is generally recommended for the initial episode of atrial fibrillation in patients in whom it is thought to be of recent onset and when there is an identifiable precipitating factor. Cardioversion is also appropriate in patients who remain symptomatic. However, the recurrence rate is sufficiently high enough that long term anticoagulation with warfarin should be continued until NSR can be proven to exist for 6 months straight.
* Elective cardioversion can be achieved either electrically or pharmacologically (using the anti-arrhythmic medications listed above.
*Unfortunately, sinus rhythm will persist in only 25% of patients who have sustained (lasting more than several days) or recurrent episode of atrial fibrillation. However, if the patient is treated long-term with an anti-arrhythmic medication, sinus rhythm will persist in about 50%.
As you can see there is much to know about atrial fibrillation. I hope that you found my review helpful and if you are in medicine, you’ve learned a couple things. If you liked what you read, feel free to leave a comment below!