Montepara Atrial Fibrillation

Etiology of AFib

Left atrial stretch (most common cause)

Right atrial stretch (not as common)

High adrenergic tone

Paroxysmal AF

AF that terminates spontaneously or with intervention within 7 days of onset

Persistent AF

Continuous AF that is sustained > 7 days and terminates with intervention

Long-standing persistent AF

Continuous AF > 12 months in duration and terminates with intervention

Permanent AF

Persistence of AF despite electrical or pharmacological cardioversion attempts

The longer a atient is in AFib, _____

The harder it is to get them out

Valvular AF

AF in the setting of moderate to severe mitral stenosis or an artificial (mechanical) heart valve

• DOACs are not FDA approved for this patient population

Pharmacological therapy options for atrial fibrillation

Rate control

Stroke prevention

Rhythm control

Uses of rate control

To minimize symptoms of AF and improve ventricular filling

Treatment of choice for persistent or permanent AF

Drug therapy options for AFib rate control

Beta blockers

Non-DHP calcium channel blockers

Digoxin

Goal digoxin levels for AFib rate control

0.8-1.2 ng/mL

General pharmacotherapy recommendations for rate control in AFib

In patients with HFrEF → Beta blocker, digoxin

Otherwise → Beta blockers, diltiazem, verapamil