Atrial Fibrillation

Steven Podnos MD

Pathophysiology

• Most Common Arrythmia• 5% of patients over 65yoa, increases with age• Associated with hypertension,

cardiomyopathy, valvular disease, ischemia, alcohol

Approach to Therapy

• Depends on severity and comorbid conditions• Rate vs. Rhythm control• Stroke prophylaxis

Rythym Control

• New Afib• Symptomatic Afib• Usually catheter ablation

Rate Control

• In absence of symptoms and combined with appropriate stroke prophylaxis, equal outcome to trying rhythm control.

• Pharmacologic/ Electrophysiology

CHADS2-stroke prophylaxis

• CHF• Hypertension• Age over 75• Diabetes• Stroke

Initial Approach

• Rate Control• Anticoagulation• Decision on Rhythm control efforts• If not know to be in afib for less than 48 hours,

need 3-4 weeks (or TEE) anticoagulation before cardioversion

Rate Control

• Calcium Channel Blockers- not the “pines”• Beta Blockers• Digoxin-only limited benefit. Adjunctive if

coexistent LV dysfunction• If drugs fail, catheter ablation

Rhythm Control

• For symptoms:• Propafenone, Flecainide for normal heart• Amiodarone/Multaq for systolic dysfunction

and afib• Ablation

Anticoagulation

• Long Term for CHADS2 score over 1-2• Coumadin vs. Pradaxa