Author: Dr Shawn Foo
We are pleased to share some important practice points on Atrial Fibrillation (AF) management that can guide your clinical practice. These insights are drawn from recent research and clinical practice, providing further insight into the care of patients with AF:
1. Prioritise Rhythm Control for AF under 75:
For patients under the age of 75 with paroxysmal or persistent AF lasting more than seven days, it is advisable to aim for a rhythm control strategy as the first-line approach.
2. Early Rhythm Control for Improved Outcomes:
Recent findings from the EAST-AFNET 4 trial suggest that early rhythm-control therapy is associated with a reduced risk of adverse cardiovascular outcomes compared to usual care. Consider this option for your eligible patients.
3. Consider Metoprolol, Bisoprolol, or Diltiazem:
After the first or second episode of AF, it is reasonable to consider medications like Metoprolol, Bisoprolol, or Diltiazem to manage the condition effectively.
4. Referral for Flecainide or Sotalol:
Patients with recurrent AF episodes despite initial medical therapy may benefit from referral for the consideration of antiarrhythmic agents like Flecainide or Sotalol.
5. Catheter Ablation for Medication-Resistant AF:
When patients continue to experience AF episodes despite antiarrhythmic medication or are intolerant to medical therapy, it is important to consider catheter ablation as a treatment option.
6. Catheter Ablation for AF with heart failure:
Catheter ablation is the preferred treatment modality in patients with AF and evidence of heart failure.
7. High Success Rates with Catheter Ablation:
Catheter ablation for AF has shown excellent results, with most patients experiencing over a 90% reduction in the burden of atrial fibrillation.
8. Permanent Pacemaker for Permanent AF with Symptoms:
In cases of permanent AF where rhythm control strategies are unsuitable, and patients continue to experience symptoms or heart failure, consider the placement of a permanent pacemaker, such as a cardiac resynchronization therapy pacemaker or left bundle branch area pacemaker, along with AV node ablation. This approach may significantly improve symptoms and reduce cardiovascular outcomes, as highlighted in the APAF-CRT study.
Should you wish to discuss these strategies further or have any questions, please do not hesitate to contact the Ascot Cardiology Group. We are here to support you and your patients in managing Atrial Fibrillation effectively.