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).

Rhythm control

  1. FA reported for more than 48 hours
  2. AF lasting for less than 48 hours

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).