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).

Anticoagulation

Anticoagulation if permanent AF or intermittent with a score CHADs-Vasc ≥ 2

Anticoagulation possible and to be evaluated case by case if CHADs-Vasc = 1

No anticoagulation if CHADs-Vasc = 0, age < 65 years and paroxystic AF.

If anticoagulation impossible or not indicated consider percutaneous closure of the left atrial appendage.

Anticoagulants:

  • Choose based on compliance.

  • Pay attention to drugs interaction and renal failure with NOAC.

  • Adapt dose if needed.

  • Evaluation of bleeding risk with the HAS-BLED score.

  • If CrCl< 30 give AVK.

  • For patients with valvular AF or with prosthetic valves only AVK can be given.

  • Coumadin (AVK) (Acenocoumarol (Sintrom) or (Phenprocoumone (Marcoumar): Target INR between 2 and 3.

  • Rivaroxaban (Xarelto): 20 mg/day or 15 mg/day.

  • Dabigatran (Pradaxa): 2x150 mg/day or 2x110 mg/day.

  • Apixaban (Eliquis): 2x5 mg/day or 2x2.5 mg/day.

  • Edoxaban (Lixiana): 30 mg/day or 60 mg/day.