Atrial fibrillation

• The first priority is to control heart rate (if tachycardia is present) and provide adequate antithrombotic treatment for preventing complications of embolism
• Patients with moderate to high risk of stroke require warfarin long term for preventing emboli; aspirin is adequate in patients with low risk of stroke
• When a patient should but cannot take warfarin, aspirin plus clopidogrel can be an intermediate option
• For long term treatment of atrial fibrillation, rate control matches rhythm control in terms of mortality and major cardiovascular events but has fewer adverse events related to the treatment and fewer hospital admissions
• Consider referring for rhythm control younger patients with lone atrial fibrillation, patients with symptomatic atrial fibrillation, and patients with atrial fibrillation secondary to a corrected precipitant
• If antiarrhythmic drugs fail to maintain sinus rhythm, percutaneous catheter ablation is an alternative for rhythm control

If patient stable and on warfarin - do not interfere.

• If atrial fibrillation present for more than one year, cardioversion usually not done.
• If atrial fibrillation present for less than one year, consider cardioversion.
• If atrial fibrillation uncontrolled, use digoxin.
• What is cause of atrial fibrillation?
  • ECG
  • CXR
  • TFT (U&E, FBC, LFT)
  • Echocardiography determines whether patient should be commenced on aspirin or warfarin.

• Patients with tachycardia plus syncope, chest pain, dyspnoea, or acute neurological symptoms should be sent immediately to hospital for urgent treatment
• Use β blockers, diltiazem, or digoxin (if heart failure is present), or a combination of these drugs at standard doses to slow heart rate in atrial fibrillation if tachycardia is present

  BHF factfiles

NICE CG36

CKS on AF