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Atrial fibrillation

What is atrial fibrillation?

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Correct refers to the management of the AF itself. Depending on the individual patient’s AF, this may involve: 

  • A rhythm control strategy: converting the heart back to its normal rhythm either via an electric shock, cardio-version, an ablation procedure, burning or freezing the origin of the arrhythmia in the heart, or with anti-arrhythmic medication. Medication that may be used includes beta-blockers or anti-arrhythmic drugs such as flecainide, sotalol or amiodarone. 

    • Some patients with paroxysmal AF can self-manage episodes with a ‘pill in the pocket’ strategy. This involves taking a dose of medication only if they have an episode of AF.

  • A rate control strategy: slowing conduction through the heart with heart rate-limiting cardiac medication. The first choice of medication is usually a beta-blocker. Alternatively, or in addition, a rate-limiting calcium channel blocker diltiazem or verapamil, or digoxin may be prescribed although the combination of a beta-blocker and verapamil should be avoided due to risk of heart block. Digoxin alone is only really now used in sedentary patients. 

    • A normal resting heart rate for adults in sinus rhythm is 60-100 beats per minute. There has been much debate about the ‘ideal’ heart rate to aim for in patients with AF, with studies comparing strict, heart rate less than 80 beats/minute, with more lenient, heart rate less than 110 beats/minute, rate control. Stricter rate control does not appear to have any particular benefits so in current guidelines the aim of treatment in AF is to reduce the resting heart rate to less than 110 beats/minute.

    Atrial fibrillation

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