Atrial Fibrillation

Author: Clifford J Mann / Editor: Jason M Kendall / Reviewer: Martin Dore, Mohamed Elwakil / Codes: A1 / Published: 15/01/2019 / Reviewed: 12/08/2024

This session is about atrial fibrillation, the most common form of cardiac dysrhythmia.

After completing this session you will be able to:

• Explain the importance of the duration of atrial fibrillation and its implications for treatment options
• Identify which patients need emergency treatment of atrial fibrillation
• Identify which patients are best suited to a rate control strategy
• Identify which patients are best suited to a rhythm control strategy
• Describe appropriate treatment options for patients presenting to the emergency department with atrial fibrillation
• Describe how to assess stroke risk in all patients who present with atrial fibrillation

References

1. National Institute for Health and Care Excellence (NICE): Atrial fibrillation: diagnosis and management. NICE guideline [NG196] Last updated: 30 June 2021
2. Haim M, Hoshen M, et al. Prospective national study of the prevalence, incidence, management and outcome of a large contemporary cohort of patients with incident non-valvular atrial fibrillation. J Am Heart Assoc. 2015 Jan 21;4(1):e001486.
3. Kishore A, Vail A, Majid A, et al. Detection of atrial fibrillation after ischemic stroke or transient ischemic attack: a systematic review and meta-analysis. Stroke. 2014 Feb;45(2):520-6.
4. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016 Oct 7;37(38):2893-2962.
5. Lowenstein SR, Gabow PA, et al. The role of alcohol in new-onset atrial fibrillation. Arch Intern Med. 1983 Oct;143(10):1882-5.
6. Scheuermeyer FX, Pourvali R, Rowe BH, Grafstein E, Heslop C, MacPhee J, McGrath L, Ward J, Heilbron B, Christenson J. Emergency Department Patients With Atrial Fibrillation or Flutter and an Acute Underlying Medical Illness May Not Benefit From Attempts to Control Rate or Rhythm. Ann Emerg Med. 2015 May;65(5):511-522.e2.
7. Recusitation council UK. Advances life support – Peri-arrest arrhythmias, 2021
8. Caldeira D, David C, Sampaio C. Rate versus rhythm control in atrial fibrillation and clinical outcomes: updated systematic review and meta-analysis of randomized controlled trials. Arch Cardiovasc Dis. 2012 Apr;105(4):226-38.
9. Nuotio I, Hartikainen JE, Grnberg T, Biancari F, Airaksinen KE. Time to cardioversion for acute atrial fibrillation and thromboembolic complications. JAMA. 2014 Aug 13;312(6):647-9.
10. Van Gelder IC, Groenveld HF, Crijns HJ, Tuininga YS, et al. Lenient versus strict rate control in patients with atrial fibrillation. N Engl J Med. 2010 Apr 15;362(15):1363-73.
11. Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2010 Feb;137(2):263-72.
12. Hagens VE, Van Veldhuisen DJ, Kamp O, et al. Effect of rate and rhythm control on left ventricular function and cardiac dimensions in patients with persistent atrial fibrillation: results from the RAte Control versus Electrical Cardioversion for Persistent Atrial Fibrillation (RACE) study. Heart Rhythm. 2005 Jan;2(1):19-24.
13. Carlson J, Miketic S, Windeler J et al. Randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation: the Strategies of Treatment of Atrial Fibrillation (STAF) Study. J Am Coll Cardiol. 2003;41(10):1690-1696)