Atrial Fibrillation (Management of)

Table of contents: Full Text (ESC Clinical Practice Guidelines)

Definition

Atrial fibrillation, Related arrhythmias

Epidemiology and prognosis

Pathophysiological mechanisms

• Atrial factors 
• Atrioventricular conduction
• Myocardial and hemodynamic consequences of atrial fibrillation
• Thromboembolism

Causes, associated conditions, clinical manifestations, and quality of life

Clinical evaluation

• Basic evaluation of the patient with atrial fibrillation
• Additional investigation of selected patients with atrial fibrillation

Management

Pharmacological and nonpharmacological therapeutic options:

• Pharmacological therapy
• Heart rate control versus rhythm control
• Rate control during atrial fibrillation
• Preventing thromboembolism
• Cardioversion of atrial fibrillation
• Pharmacological agents to maintain sinus rhythm 
• Out-of-hospital initiation of antiarrhythmic drugs in patients with atrial fibrillation
• Drugs under development

Direct-current cardioversion of atrial fibrillation and flutter:

• Terminology
• Technical aspects
• Procedural aspects
• Direct-current cardioversion in patients with implanted pacemakers and defibrillators
• Risks and complications of directcurrent cardioversion of atrial fibrillation
• Pharmacological enhancement of direct-current cardioversion
• Prevention of thromboembolism in patients with atrial fibrillation undergoing cardioversion

Maintenance of sinus rhythm:

• Pharmacological therapy
• General approach to antiarrhythmic drug therapy
• Selection of antiarrhythmic agents in patients with cardiac diseases
• Nonpharmacological therapy for atrial fibrillation
• Suppression of atrial fibrillation through pacing

Special considerations:

• Postoperative AF
• Acute myocardial infarction
• Wolff-Parkinson-White (WPW) preexcitation syndromes
• Hyperthyroidism
• Pregnancy
• Hypertrophic cardiomyopathy
• Pulmonary diseases
• Primary prevention

Proposed management strategies

Overview of algorithms for management of patients with atrial fibrillation:

• Newly discovered atrial fibrillation
• Recurrent paroxysmal atrial fibrillation
• Recurrent persistent atrial fibrillation
• Permanent atrial fibrillation