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Atrial fibrillation (AF) is managed differently in different patient groups depending on a number of factors, including whether the patient's condition is paroxysmal, persistent or permanent. Patients with permanent AF, and patients with persistent AF who are aged over 65, with coronary artery disease or a contraindication to cardioversion (e.g. structural heart disease) are typically managed via rate control.
Prior to starting rate control treatment for persistent and permanent AF, patients are stratified according to their risk of stroke, and assigned either no thromboprophylaxis, aspirin 75-300 mg ORAL daily or adjusted-dose warfarin sodium ORAL daily. Factors associated with requiring anticoagulation include advanced age, history of cerebrovascular disease or risk factors for cardiovascular disease, and impaired cardiac function.
Patients are initially prescribed a beta blocker or a rate-limiting calcium channel antagonist such as verapamil, with therapy targeting a resting heart rate of 90 BPM. If adequate rate control is not achieved, digoxin is added to the prescription. Digoxin is now rarely used as monotherapy for atrial fibrillation as it only provides rate control at rest, although it may be suitable for sedentary patients.
Permanent Atrial Fibrillation
Established AF which does not terminate, or which has relapsed after termination.
Persistent Atrial Fibrillation
Recurrent AF which does not terminate spontaneously within 7 days of onset.
Paroxysmal Atrial Fibrillation
Recurrent AF which terminates spontaneously within 7 days of onset.
