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[Atrial fibrillation--from delirium cordis to therapeutic challenge]
1II. Medizinischen Abteilung, Krankenanstalt Rudolfstiftung, Wien.
Insights
Atrial fibrillation management involves cardioversion and rate control, prioritizing class-III antiarrhythmics over class-I due to safety concerns. Anticoagulation and aspirin reduce embolism risk in nonvalvular cases.
Area of Science:
- Cardiology
- Electrophysiology
- Internal Medicine
Context:
- Atrial fibrillation (AF) is a common arrhythmia, increasing with age and associated with significant risks.
- Patients with AF may have underlying heart disease or develop it independently.
- Hemodynamic instability and embolic events are critical concerns in AF management.
Purpose:
- To outline current strategies for managing atrial fibrillation.
- To discuss the risks and benefits of various treatment modalities.
- To provide guidance on rate control, rhythm control, and embolism prevention.
Summary:
- Cardioversion (medical or electrical) is recommended for unstable AF, with a preference for class-III antiarrhythmics post-procedure due to the risks of class-I agents.
- Heart rate control in persistent AF is best managed with digitalis glycosides at rest and calcium channel blockers or beta-blockers during exercise.
- Oral anticoagulation and aspirin (300 mg daily) are recommended to reduce embolism risk in nonvalvular AF.
- Specialized procedures like AV-node ablation, accessory pathway ablation, or the maze procedure may be considered in select cases.
Impact:
- Improved patient outcomes through optimized AF management strategies.
- Reduced risk of stroke and other embolic complications.
- Enhanced quality of life for individuals with atrial fibrillation.
Abstract:
Atrial fibrillation may develop in patients without (line atrial fibrillation) or with heart disease. Its prevalence raises with age. Medical or electrical cardioversion should be considered in view of the unfavourable hemodynamics and the increased risk of embolic events. Class-I antiarrhythmics given to sustain sinus rhythm after cardioversion are fraught with the risk of sudden death and should therefore be replaced by class-III antiarrhythmics. Control of heart rate in persisting atrial fibrillation is achieved best by digitalis glycosides at rest and by calcium channel blockers of the verapamil type or beta blockers during exercise. The risk of embolism in nonvalvular atrial fibrillation is reduced by mild oral anticoagulation and, probably to some extent, also by aspirin (300 mg daily). Ablation of the AV-node or an accessory pathway or heart surgery (maze procedure) may provide help in special cases.