1, 2 Lenient rate control to achieve a resting rate less than 110 bpm is reasonable in the majority of patients. Table 1 lists common causes of atrial fibrillation.īeta blockers (e.g., metoprolol, esmolol, propranolol) or nondihydropyridine calcium channel blockers (e.g., diltiazem, verapamil) are used to achieve heart rate goals. When due to noncardiac disease, it is referred to as secondary atrial fibrillation treating its cause often resolves the arrhythmia. 1, 2, 12 Atrial fibrillation caused by valvular disease carries a higher risk of stroke than nonvalvular atrial fibrillation. Persistent atrial fibrillation lasts more than seven days and causes atrial remodeling, which leads to its perpetuation. 1, 2 Paroxysmal and permanent forms carry the same long-term risk of stroke. 1, 2 Permanent atrial fibrillation indicates a decision to discontinue attempts to restore or maintain sinus rhythm. 1, 2 Paroxysmal atrial fibrillation is episodic and resolves spontaneously or with intervention within seven days. Nonvalvular atrial fibrillation, which occurs in the absence of rheumatic valve disease, a mechanical or bioprosthetic valve, or mitral valve abnormalities, is the most common form of atrial fibrillation. Surgical treatments for atrial fibrillation are reserved for patients who are undergoing cardiac surgery for other reasons.Ītrial fibrillation results from several disease processes, each with different prognoses. Another percutaneous approach to occlusion, wherein the left atrium is closed off using the Lariat, is also available, but data on its long-term effectiveness and safety are still limited. Two implantable devices used to occlude the appendage, the Watchman and the Amplatzer Cardiac Plug, appear to be as effective as warfarin in preventing stroke, but they are invasive. Left atrial appendage obliteration is an option for reducing stroke risk. Selection of therapy should be individualized based on risks and potential benefits, cost, and patient preference. Warfarin, dabigatran, factor Xa inhibitors (e.g., rivaroxaban, apixaban, edoxaban), and aspirin are options for stroke prevention. Scores of 3 or greater indicate high risk. The HAS-BLED score estimates the risk of bleeding. The CHADS 2 and the CHA 2DS 2-VASc scoring systems assess the risk of stroke, with a score of 2 or greater indicating a need for anticoagulation. Anticoagulation reduces the risk of stroke while increasing the risk of bleeding. Ablation therapy is used to destroy abnormal foci responsible for atrial fibrillation. For most patients, rate control is preferred to rhythm control. when to treat with rate control, and, in either case, how to best reduce the risk of stroke. Treatment is based on decisions made regarding when to convert to normal sinus rhythm vs. Because normal electrocardiographic findings do not rule out atrial fibrillation, home monitoring is recommended if there is clinical suspicion of arrhythmia despite normal test results. Pulse rate is sensitive, but not specific, for diagnosis, and suspected atrial fibrillation should be confirmed with 12-lead electrocardiography. It is the most common arrhythmia and a major source of morbidity and mortality its prevalence increases with age. Atrial fibrillation is a supraventricular arrhythmia that adversely affects cardiac function and increases the risk of stroke.
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