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Atrial Fibrillation

I read a great article recently on the NPS Medicine Wise site about atrial fibrillation.

The authors identified that presentations to emergency departments for the arrhythmia are on the increase. It is the most common arrhythmia that people present with and it accounts for over 30% of hospital admissions for arrhythmia.

The prevalence of atrial fibrillation (AF) in our population is said to be between 2-4%, however, this does not take into account the number of people who are walking around with AF and are yet to be diagnosed. A number of people will have a run of AF and then spontaneously revert to sinus rhythm and think the flutter they felt was to do with anxiety or exertion rather than their heart changing rhythm. Other patients will present for routine screening and found to be in AF without experiencing any great symptoms.

Untreated atrial fibrillation is associated with an increased risk of stroke and heart failure.

Atrial fibrillation can be defined as valvular or non-valvular. Valvular is diagnosed in patients with mitral valve stenosis or patients who have a mechanical heart valve.

There are four classifications of AF
  1. Paroxysmal – lasting less than 7 days and may either spontaneously revert or require electro cardioversion
  2. Persistent – lasting longer than 7 days and does not self-limit
  3. Long-standing – lasts longer than a year even with rhythm control strategies
  4. Permanent – the control strategies have been unsuccessful and the medical officer and the patient come to the conclusion that it is permanent.

Once a diagnostic workup has been completed the CHA2DS2-VASc score stroke risk tool and the HAS-BLED score are applied to determine the most appropriate treatment.

The management of atrial fibrillation revolves around stroke prevention, aggressive risk-factor management, and acute and long-term rate or rhythm control. Catheter ablation may also be considered.

Anticoagulant therapy is the mainstay of stroke prevention in AF – interestingly warfarin remains the drug of choice over direct oral anticoagulants as “Evidence is lacking for their use in patients with mitral stenosis or a metallic valve replacement”

To complete your understanding of the management of atrial fibrillation I direct you to the great article on NPS click here>>