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Last Updated: 4/8/2014  

Atrial Fibrillation

Prevention
  • Use an ACE inhibitor or ARB for primary prevention of AF in patients with hypertension-related LVH, a reduced ejection fraction, or HF.

  • Use statins to prevent AF in patients with ischemic heart disease.

Diagnosis
  • Diagnose AF with resting ECG demonstrating absent P waves and an irregular ventricular response.

  • Obtain continuous ambulatory cardiac monitoring or cardiac event monitoring for patients with intermittent symptoms.

  • Selectively obtain additional laboratory data to determine AF etiology; for most patients this includes hemoglobin, serum electrolytes, TSH, pulse oximetry, and echocardiography.

Therapy
  • Use β-blockers or calcium-channel blockers as first-line agents to control heart rate.

  • Use a risk stratification tool, such as CHADS2 or CHA2DS2-VASc to determine the long-term thromboembolic risk.

  • Treat patients at lowest risk for thromboembolism with antiplatelet therapy or no therapy.

  • Treat patients at increased risk for thromboembolism with warfarin, a direct thrombin inhibitor, or a factor Xa inhibitor.

  • Consider elective cardioversion for patients whose symptoms are not controlled with a rate-control strategy.

  • Note that catheter-based ablation of the AV node with placement of a ventricular pacer is an option for patients poorly controlled with or intolerant of drug therapy.

  • Perform emergent electrical cardioversion in patients with AF who are hemodynamically unstable.

DOI: 10.7326/d027
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
Victor A. Ferrari, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. David Callans, MD, FACC has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Susan Wiegers, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Jonathan L. Halperin, MD, FACP, FACC, FACP, FAHA, MSVM has received consulting fees from AstraZeneca, Bayer AG HealthCare, Biotronik, Boehringer Ingelheim, Boston Scientific, Daiicho Sankyo, Janssen, Johnson & Johnson, Medtronic, Ortho-McNeil-Janssen Pharmaceuticals, Pfizer, Sanofi-Aventis. Noah Moss, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Deborah Korenstein, MD, FACP, Editor in Chief, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Richard B. Lynn, MD, FACP, Editor, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
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