Treatment of atrial fibrillation

May 2017
Atrial fibrillation (AF) is a long-term disease (LTD). Doctors need to know how to deal with patients affected by this heart disease.

AF, which is a severe chronic disorder of the heart rhythm, affects 1% of the population, but from the age of 80, the figure reaches 8%. As the population is growing old, this pathology is affecting more and more patients.


Definition


  • Very frequent diseaseatrial fibrillation is an anarchistic contraction of the atria, parts of the heart which receive blood.
  • Several types of atrial fibrillation:
    • Paroxystic: ends in one week, often within 48 hours, repeating;
    • Persistent: recurring and requiring a treatment;
    • Permanent.

Initial check-up

  • To determine an atrial fibrillation, here are this pathology's associated symptoms :
    • Difficulty of breathing (dyspnea),
    • Palpitations,
    • Malaise,
    • Fainting,
    • Tiredness,
    • Thoracic disturbance,
    • Cerebral vascular accident (CVA),
    • Transient ischemic attack (TIA).
  • Questions to be asked to a suffering patient of AF:
    • Former episodes,
    • Starting factors of AF,
    • Frequency of AF,
    • Its duration,
    • The way in which the attacks end
    • Effects of the treatment,
    • Signs of hemodynamic instability (often requiring an emergency hospitalisation),
    • Type of AF.
  • Examinations are recommended, inter alia:
    • ECG (electrocardiogram),
      • Confirms the arrhythmia
      • Measures the heart rate (HR)
      • Searches for another heart pathology
    • Thyreostimuline (TSH),
    • Transthoracic Echocardiogram (TTE) (if subjacent heart disease suspected or within the framework of a cardioversion),
    • Hematologic and biochemical examinations
      • Glycemia,
      • Creatinin,
      • Complete blood count.
    • Depending on the cases, combine with:
      • Chest radiography,
      • Transesophageal Echocardiography (TEE),
      • Holter ECG,
      • Cardiac stress test.

Treatment

  • The goal of therapeutic management:
    • To decrease functional disturbance,
    • To prevent thromboembolic events,
    • To avoid the aggravation of a possible latent heart disease,
    • To work out a strategy of management.

Prevent thromboembolic accidents with a antithrombotic treatment

  • In case of AF:
    • AVK: high-risk patients,
    • Aspirin: low-risk patients,
    • AVK or aspirin according to the case: patients with risk moderate.
  • In case of a cardioversion:
    • Patient in AF for more than 48 H: 3 weeks before and one month afterwards, AVK;
    • Patient in AF for less than 48 H: anticoagulant treatment, according to the risks.

Treating the rhythm disorder

  • To control HR, for permanent or persistent AF: beta-blockers and/or calcium antagonists bradycardia .
  • To control the heart rhythm:
    • Cardioversion (persistant AF)
      • Electric
      • Pharmacological
    • Drug treatment to maintain the sinus rhythm (amiodarone, flecainide, propafenone, sotalol, even cibenzoline, disopyramide and Quinidine )
    • Other treatments
      • Endocavitary ablation of the AF
      • Operative treatments

Follow-up of a patient suffering from AF

  • Follow-up allows assessing :
    • Thromboembolic risks
    • Benefit and risks of anticoagulant treatment
    • Benefit and risks of antiarythmic treatment.


A consultation every 6 months is recommended, questioning the patient (life, symptoms, treatment...). Complementary examinations can be carried out.

Sources


Atrial Fibrillation Association (AFA)
Photographic copyright: Cudazi | Dreamstime.com

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