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Atrial Fibrillation Rate Control

Aka: Atrial Fibrillation Rate Control
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  1. See Also
    1. Guidelines 2000 CPR and Emergency Cardiovascular Care
    2. Atrial Fibrillation
    3. Atrial Fibrillation Acute Management
    4. Atrial Fibrillation Anticoagulation
    5. Atrial Fibrillation Cardioversion
  2. Indications
    1. Chronic control
      1. Age over 65 years
      2. Coronary Artery Disease
      3. Contraindications to Antiarrhythmic medications
      4. Cardioversion unlikely to be effective (e.g. atrial enlargement)
    2. Acute episode
      1. Atrial Fibrillation with rapid ventricular rate
  3. Precautions
    1. Beware agents which may cardiovert Atrial Fib >48 hours
      1. Risk of embolic complications
  4. Exam: Target Heart Rate
    1. Heart Rate at rest: <80 bpm
    2. Heart Rate with Exercise: <110 bpm
  5. Protocol: Rate Control if WPW Syndrome with preserved heart function
    1. General
      1. Risk of embolus if rhythm cardioverts
      2. Consider Atrial Fibrillation Anticoagulation
    2. Avoid Harmful agents
      1. Adenosine
      2. Beta Blocker
      3. Calcium Channel Blocker
      4. Digoxin
    3. Recommended agents (Use only 1 agent)
      1. Electrical Synchronized Cardioversion if unstable
      2. Class IA Agents
        1. Procainamide
      3. Class IC Agents
        1. Propafenone (Rythmol)
        2. Flecainide (Tambocor)
      4. Class III Agents
        1. Amiodarone (Cordarone)
        2. Sotalol (Betapace)
  6. Protocol: Rate control if WPW with Ejection Fraction <40%
    1. General
      1. Risk of embolus if rhythm cardioverts
      2. Consider Atrial Fibrillation Anticoagulation
    2. Recommended agents
      1. Electrical Synchronized Cardioversion
      2. Amiodarone (Cordarone)
  7. Protocol: Rate control if Heart function preserved (No WPW)
    1. General
      1. Risk of embolus if rhythm cardioverts
      2. Consider Atrial Fibrillation Anticoagulation
    2. Recommended agents
      1. Beta Blockers (preferred)
        1. Metoprolol (Lopressor) - preferred
        2. Propranolol (Inderal)
        3. Esmolol (Brevibloc)
      2. Calcium Channel Blocker
        1. Verapamil (Calan)
        2. Diltiazem (Cardizem) - preferred
          1. See Diltiazem for dosing protocol
  8. Protocol: Rate control if Ejection Fraction <40% (No WPW)
    1. General
      1. Risk of embolus if rhythm cardioverts
      2. Consider Atrial Fibrillation Anticoagulation
    2. Recommended agents
      1. Digoxin (Lanoxin)
      2. Diltiazem (Cardizem) - preferred
      3. Amiodarone
  9. Management: Choosing longterm rate versus rhythm control
    1. Rate control has less drug-related adverse effects
    2. Rate control has equivalent efficacy to rhythm control
      1. Same survival benefit
      2. Same Cerebrovascular Accident risk
    3. Rhythm control may offer benefit in age <65 years
    4. References
      1. Wyse (2002) N Engl J Med 347:1825-33
  10. References
    1. Dell&#39;Orfano (1998) Am Fam Physician, 58(2):471-80
    2. Hebbar (2002) Am Fam Physician 65(12):2479-86
    3. King (2002) Am Fam Physician 66:249-56
    4. (2000) Circulation, 102(Suppl I):86-9
    5. http://www.circulationaha.org

Atrial Fibrillation (C0004238)

Definition (NCI) A supraventricular arrhythmia characterized by uncoordinated atrial myocardium activation due to multiple reentry circuits with consequent deterioration of atrial mechanical function. Instead of intermittently contracting, the atria quiver continuously in a chaotic pattern, causing a totally irregular, often tachycardia ventricular rate. On the ECG it is described by the replacement of consistent P waves by rapid oscillations or fibrillatory waves that vary in size, shape, and timing, associated with an irregular, frequently rapid ventricular response when atrioventricular conduction is intact. (NCI)
Definition (NCI) An arrhythmia in which minute areas of the atrial myocardium are in various uncoordinated stages of depolarization and repolarization; instead of intermittently contracting, the atria quiver continuously in a chaotic pattern, causing a totally irregular, often rapid ventricular rate.
Definition (NCI) A disorder characterized by a dysrhythmia without discernible P waves and an irregular ventricular response due to multiple reentry circuits. The rhythm disturbance originates above the ventricles.
Definition (CHV) rapid tremor and shake of upper chambers of the heart
Definition (CHV) rapid tremor and shake of upper chambers of the heart
Definition (CHV) rapid tremor and shake of upper chambers of the heart
Definition (CHV) rapid tremor and shake of upper chambers of the heart
Definition (CHV) rapid tremor and shake of upper chambers of the heart
Definition (CHV) rapid tremor and shake of upper chambers of the heart
Definition (MEDLINEPLUS)

An arrhythmia is a problem with the speed or rhythm of the heartbeat. Atrial fibrillation (AF) is the most common type of arrhythmia. The cause is a disorder in the heart’s electrical system.

Often, people who have AF may not even feel symptoms. But you may feel

  • palpitations -- an abnormal rapid heartbeat
  • shortness of breath
  • weakness or difficulty exercising
  • chest pain
  • dizziness or fainting
  • fatigue
  • confusion

AF can lead to an increased risk of stroke. In many patients, it can also cause chest pain, heart attack, or heart failure.

Doctors diagnose AF using family and medical history, a physical exam, and a test called an electrocardiogram (EKG), which looks at the electrical waves your heart makes. Treatments include medicines and procedures to restore normal rhythm.

NIH: National Heart, Lung, and Blood Institute
Definition (CSP) disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions.
Definition (NCI) A supraventricular arrhythmia characterized by uncoordinated atrial myocardium activation due to multiple reentry circuits with consequent deterioration of atrial mechanical function. Instead of intermittently contracting, the atria quiver continuously in a chaotic pattern, causing a totally irregular, often tachycardia ventricular rate. On the ECG it is described by the replacement of consistent P waves by rapid oscillations or fibrillatory waves that vary in size, shape, and timing, associated with an irregular, frequently rapid ventricular response when atrioventricular conduction is intact.
Definition (MSH) Abnormal cardiac rhythm that is characterized by rapid, uncoordinated firing of electrical impulses in the upper chambers of the heart (HEART ATRIA). In such case, blood cannot be effectively pumped into the lower chambers of the heart (HEART VENTRICLES). It is caused by abnormal impulse generation.
Concepts Pathologic Function (T046)
MSH D001281
ICD9 427.31
ICD10 I48.0
SnomedCT 49436004, 155364009, 266306001
English Atrial Fibrillations, Auricular Fibrillation, Auricular Fibrillations, Fibrillations, Atrial, Fibrillations, Auricular, FIBRILLATION ATRIAL, ATRIAL FIBRILLATION, AURICULAR FIBRILLATION, Auricular fibrillation, Fibrillation, Atrial, Fibrillation, Auricular, AF, atrial fibrillation, atrial fibrillation (diagnosis), a fib, af, afib, Afib, AFib, Fibrillation atrial, Atrial Fibrillation [Disease/Finding], Fibrillation;atrial, atrial fibrillation (AF), auricular fibrillations, atrial fibrillations, Atrial fibrillation, AF - Atrial fibrillation, Atrial fibrillation (disorder), atrium; fibrillation, auricular; fibrillation, fibrillation; atrial or auricular, Fibrillation - atrial, Atrial Fibrillation, auricular fibrillation
French FIBRILLATION AURICULAIRE, FA, AFib, Fibrillation auriculaire, Fibrillation atriale
German VORHOFFLIMMERN, AF, Afib, Flimmern Vorhof, Herzohrflimmern, HERZVORHOFFLIMMERN, Vorhofflimmern, Aurikuläres Flimmern
Portuguese FIBRILACAO AURICULAR, FA, FIBRILHACAO AURICULAR, Fibrilhação auricular, Fibrilação Atrial, Fibrilação Auricular
Spanish FIBRILACION AURICULAR, FA, Fibrilación atrial, Atrial fibrillation, Fibrillation - atrial, AURICULAR, FIBRILACION, fibrilación auricular (trastorno), fibrilación auricular, Fibrilación auricular, Fibrilación Atrial, Fibrilación Auricular, Fibrilacion Atrial, Fibrilacion Auricular
Dutch AFib, AF, atriumfibrillatie, hartoorfibrilleren, atrium; fibrilleren, auriculair; fibrilleren, fibrilleren; atrium of auriculair, atriale fibrillatie, Atriumfibrillatie, Boezemfibrillatie, Fibrillatie, atrium-, Fibrillatie, boezem-, Fibrilleren, boezem-
Swedish Förmaksflimmer
Japanese ｼﾝﾎﾞｳｻｲﾄﾞｳ, 心房細動, 心房性細動
Finnish Eteisvärinä
Russian USHKA PREDSERDIIA FIBRILLIATSIIA, PREDSERDII FIBRILLIATSIIA, ПРЕДСЕРДИЙ ФИБРИЛЛЯЦИЯ, УШКА ПРЕДСЕРДИЯ ФИБРИЛЛЯЦИЯ
Czech Fibrilace ouška, Fibrilace síní, fibrilace síní, síňová fibrilace, FiS
Italian Fibrillazione auricolare, Fibrillazione atriale
Croatian ATRIJ, FIBRILACIJA
Polish Migotanie przedsionków
Hungarian AFib, Fibrillatio atrialis, Pitvarfibrillatio
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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