Atrial fibrillation (AF)

Diagnostic and therapeutic approach

  1. Diagnosis
  2. Treatment
  3. Scores
  4. Pharmaceuticals
  5. ESC recommandations

Treatment

When AF is diagnosed we have to decide about:

  1. Eventual anticoagulation based on CHADs-VASC score. Bleeding risk must be calculated with the HAS-BLED score.
  2. Rhythm control = cardioversion.
  3. Heart rate control.

Alternative to anticoagulation exists, like percutaneous closure of the left atrial appendage (LAA).

Rhythm control

  1. FA reported for more than 48 hours
  2. AF lasting for less than 48 hours

AF lasting for less than 48 hours

Anticoagulation and cardioversion

Electrical cardioversion

  • If AF 100-150 Joules in synchrone mode.
  • If atrial flutter begin with 50 Joules in synchrone mode.

Drug cardioversion

If underlying heart disease:

  • [Amiodarone] (# 286) (Cordarone) (i.v. (150-300 mg i.v. in 15 min, then 3x 200 mg / day p.o. for 10 days, then 200 mg / day). Otherwise (no underlying heart disease):
  • [Flecainide] (# 293) (Tambocor) (2 mg / kg in 10 min or 200-300 mg orally.).
  • [Propafenone] (# 295) (Rytmonorm) (2 mg / kg in 10 min or 300-450 mg per os.).
  • [Dronedarone] (# 292) (Multaq) (2x400 mg orally).
  • [Vernakalant] (# 299) (Brinavess) (3 mg / kg in 10 min).
  • [Ibutilide] (# 294) (Corvert) (10 ml in 10 min = 0.87 mg i.v. If <60 kg 0.1 ml / kg..).