Atrial fibrillation

- Should look for AF in patient who presents with dyspnea, palpitation, syncope/dizziness, chest discomfort, stroke/TIA
- In patient with permanent AF who need treatment for rate control, beta blocker or rate-limiting CCB should be preffer initial monotherapy, digoxin is considered in predominantly sedentary patient
- In patient with persistent AF considered for pharmacological cardioversion, Class Ic drug (flecainide or propafenone) should be drug of choice in the absence of structural heart disease and amiodarone in the presence of structural heart disease
- rate control strategy should be the preferred initial option in persistent AF patient with
  ~ age over 65
  ~ coronary heart disease
  ~ with contraindication to antiarrhythmic drug
  ~ unsuitable for cardioversion
  ~ without congestive heart failure
- rhythm control strategy should be the preferred initial option in persistent AF patient with
  ~ younger patient
  ~ symptomatic
  ~ presenting for first time with lone AF
  ~ those with AF secondary to a treated/corrected precipitant
  ~ with congestive heart failure
- patient should be maintained on therapeutic anticoagulation with warfarin to keep INR between 2.0-3.0 for minimum of 3 weeks before cardioversion and 4 weeks after cardioversion





Reference: NICE clinical guideline 36 Atrial fibrillation