Atrial fibrillation (AF)

Diagnostic and therapeutic approach

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).

FA reported for more than 48 hours

  1. Anticoagulation for at least 3 weeks
  2. Check the frequency until 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 cardiopathy:

  • Amiodarone (Cordarone): i.v (150-300 mg i.v. in 15 min, then 3x 200 mg/j p.o. for 10 day, then 200 mg/j).
  • Dronedarone (Multaq): (400 mg orally).

If no underlying heart disease or minimal:

  • [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) (400 mg orally).
  • [Vernakalant] (# 299) (Brinavess): (3 mg / kg in 10 min).
  • [Ibutilide] (# 294) (Corvert): If weight> 60 kg: 10 ml in 10 minutes. If weight <60 kg: 0.1 ml / kg 10 min. Can be repeated after 10 minutes. if arrhythmia persists.

Treatment of chronic maintenance of sinus rhythm

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).
  • [Dronedarone] (# 292) (Multaq) (2x400 mg / day)

If ischemic heart disease:

  • [Amiodarone] (# 286) (Cordarone): (100-200 mg / day).
  • [Dronedarone] (# 292) (Multaq) (2x400 mg / day).
  • [Sotalol] (# 297) (Sotalex): (80-320 mg / day).

If no underlying heart disease or minimal:

  • [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 orally.).
  • [Dronedarone] (# 292) (Multaq) (2x400 mg / day).
  • [Sotalol] (# 297) (Sotalex): (80-320 mg / day).

If failure:

  • [Amiodarone] (# 286) (Cordarone): (100-200 mg / day).