Management of atrial fibrillation (AF)

Atrial fibrillation. The tracing demonstrates the absence of P waves (long arrow), as well as the presence of the fine f waves of atrial fibrillation (short arrows). Note the irregularity of the ventricular response, as seen from the variable R-R interval (brackets). [Source]

Common cardiac and non-cardiac causes of aftial fibrillation.

It is not always possible to restore and maintain sinus rhythm in patients with AF.

If sinus rhythm cannot be maintained, treatment should be directed towards controlling the heart rate with

• digoxin, 
• ß-blockers, 
• rate-limiting calcium-channel blockers (verapamil or diltiazem) or 
• amiodarone. 

ß-Blockers and calcium-channel blockers are often more effective than digoxin at controlling the heart rate during exercise.

For patients who remain poorly controlled despite medical therapy, transvenous catheter radiofrequency ablation of the atrioventricular (AV) node with permanent pacemaker implantation can be performed.

Classification of atrial fibrillation.

Initial approach to the patient with acute atrial fibrillation. (IV = intravenous; J = joule; TEE = transesophageal echocardiography)

Information from Falk RH. Atrial fibrillation. N Engl J Med 2001;344:1067–78.

[Source]

Atrial fibrillation care pathway.

Atrial fibrillation: Treatment strategy decision tree.

Atrial fibrillation: cardioversion with TOE-guided strategy.

Atrial fibrillation: Cardioversion treatment algorithm.

Rhythm-control treatment algorithm for persistent atrial fibrillation.

Rate-control treatment for permanent atrial fibrillation.

Rhythm-control treatment algorithm for paroxysmal AF.

Haemodynamically unstable atrial fibrillation treatment algorithm.

Stroke risk stratification algorithm.

Further reading:

1. The management of atrial fibrillation. [NICE]