Treatment of Atrial Fibrillation
Atrial fibrillation (AFib) is the most common cardiac arrhythmia, characterized by rapid and irregular atrial beating. It significantly increases stroke and heart failure risk.
Atrial fibrillation (AFib) is the most common cardiac arrhythmia, characterized by rapid and irregular atrial beating. It significantly increases stroke and heart failure risk.
First-Line Treatment Principles
- ✓Risk factor modification: target BP <130/80 mmHg in most patients, LDL according to risk category
- ✓Antiplatelet therapy (aspirin or P2Y12 inhibitor) for established atherosclerotic disease
- ✓ACE inhibitor or ARB for heart failure with reduced ejection fraction (HFrEF) and post-MI LV dysfunction
- ✓Beta-blocker for rate control, post-MI, and stable HFrEF
- ✓Statin therapy for all patients with established ASCVD or high CV risk
Medications Used in Atrial Fibrillation
Warfarin is an anticoagulant that prevents blood clot formation and is used to treat or prevent deep vein thrombosis, pulmonary embolism, and atrial fibrillation.
Rivaroxaban is an anticoagulant that prevents blood clot formation and is used to treat or prevent deep vein thrombosis, pulmonary embolism, and atrial fibrillation.
Apixaban is an anticoagulant that prevents blood clot formation and is used to treat or prevent deep vein thrombosis, pulmonary embolism, and atrial fibrillation.
Dabigatran is an anticoagulant that prevents blood clot formation and is used to treat or prevent deep vein thrombosis, pulmonary embolism, and atrial fibrillation.
Edoxaban is an anticoagulant that prevents blood clot formation and is used to treat or prevent deep vein thrombosis, pulmonary embolism, and atrial fibrillation.
Heparin is an anticoagulant that prevents blood clot formation and is used to treat or prevent deep vein thrombosis, pulmonary embolism, and atrial fibrillation.
Enoxaparin is an anticoagulant that prevents blood clot formation and is used to treat or prevent deep vein thrombosis, pulmonary embolism, and atrial fibrillation.
Dalteparin is an anticoagulant that prevents blood clot formation and is used to treat or prevent deep vein thrombosis, pulmonary embolism, and atrial fibrillation.
Non-Pharmacological Management
- •Cardiac rehabilitation program after MI, HF, or revascularisation
- •Dietary modification: Mediterranean or DASH diet; restrict sodium <2g/day in HF
- •Regular aerobic exercise: 150 min/week moderate intensity (when stable)
- •Smoking cessation — reduces CV event risk by 30–50% within 1 year
- •Weight management: target BMI 20–25 kg/m²
- •Alcohol restriction: ≤2 units/day men, ≤1 unit/day women
- •Stress reduction and sleep optimisation
Treatment Goals
Monitoring Parameters
- ◆BP and heart rate at every clinical visit
- ◆ECG: at baseline, after medication changes, and when symptomatic
- ◆Echocardiogram: for HF monitoring (EF, wall motion) — annually or after therapy change
- ◆Lipid panel: 4–12 weeks after statin initiation or dose change; then annually
- ◆Renal function and electrolytes (eGFR, K+): within 1–2 weeks of starting ACE inhibitor/ARB/diuretic
- ◆HbA1c if diabetic (target <7%); weight and fluid balance in HF
- ◆INR monitoring for warfarin therapy (target INR 2–3 for most indications)
Escalation Criteria
- →Refractory angina despite maximal medical therapy → invasive assessment (coronary angiography)
- →Worsening HF despite GDMT → device therapy consideration (ICD, CRT) or specialist referral
- →Uncontrolled BP >180/110 on ≥3 agents → secondary hypertension workup
- →New or worsening arrhythmia → cardiology review
- →Acute coronary syndrome: activate emergency pathway immediately
Special Populations
Clinical Insights
Compare With Similar Conditions
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