Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia; despite many available guidelines the optimal management strategy remains elusive.
The most common presentations of acute AF are palpitations, breathlessness, syncope, dizziness, chest pain, transient ischaemic attack (TIA) and stroke. Patients may need urgent electrical cardioversion (ECV) or pharmacological cardioversion (PCV) and long term anticoagulation therapy.
This review aims to discuss some issues surrounding the early management of acute AF in the Acute Medical Unit.
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References
- Levy S, Camm AJ, Saksena S et al. International consensus on nomenclature of atrial fibrillation; a collaborative project of the Working group on Arrhythmias and the Working group on Cardiac Pacing of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology, Europace. 2003; 5(2): 119–22.
- Kannel WB, Wolf PA, Benjamin EJ et al. Prevalence, incidence, prognosis and predisposing conditions for atrial fibrillation: population-based estimates. American journal of Cardiology. 1998; 82(8A): 2N–9N.
- Lip GY, Tean KN, Dunn FG. Treatment of atrial fibrillation in a district general hospital. British Heart Journal 1994; 71(1): 92–5.
- Vecht RJ, Nicolaides EP, Ikweuke JK et al. Incidence and prevention of Supraventricular tachyarrhythmia’s after coronary bypass surgery. International Journal of Cardiology. 1986; 13(2): 125–34.
- Almassi GH, Schowalter T, Nicolosi AC et al . Atrial Fibrillation after cardiac surgery: A major morbid event. Annals of Surgery. 1997; 226(4):501–11.
- Benjamin EJ, Levy D, Vaziri SM et al. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. Journal of the American Medical Association. 1994; 271(11): 840–4.
- Mitchael JA, Stiell IG, Agarwal S et al. Cardioversion of paroxysmal atrial fibrillation in the emergency department. Annals of Emergency Medicine. 1999; 33(4): 379–87.
- Singer DE, Albers GW, Dalen JE et al. Anti thrombotic therapy in Atrial Fibrillation. The Seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest. 204; 126(3 Suppl): 429S–456S.
- Wolf PA, Kannel WB, McGee DL et al . Duration of Atrial Fibrillation and eminence of stroke: the Framingham Study. Stroke. 1983; 14(5):
664–7. - Narasimham C, Blanck Z, Akhtar M. Atrioventricular nodal modification and atrioventricular junctional ablation for control of ventricular rate in atrial fibrillation. J Cardiovasc Electrophysiol 1998; 9: Suppl: S146–S150.
- Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: The Framingham Study. Stroke 1991; 22: 983–8.
- Rathore SS, Curtis JP, WangY et al. Association of serum Digoxin concentration and outcomes in patients with heart failure. JAMA. 2003; 289: 871–78.
- The Atrial Fibrillation follow up Investigation of Rhythm management (AFFIRM) Investigators. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002; 347: 1825–33.
- The Cardiac Arrhythmia Suppression Trial II Investigators. Effect of the antiarrhythmics agent moricizine on survival after myocardial infarction. N Engl J Med. 1992; 327: 227–33.
- Warfarin versus Aspirin for prevention of thromboembolism in atrial fibrillation: Stroke prevention in Atrial Fibrillation II Study. Lancet 1994;343: 687–91.
- Alt E, Ammer R, Schmitt C, et al: A comparison of treatment of atrial fibrillation with low-energy intracardiac cardioversion and conventional external cardioversion. Eur Heat J 1997; 18: 1796–1804.
- Scott CD, McComb JM, Dark JH: Heart rate and late mortality in cardiac transplant recipients. Eu Heart J. 1993; 14: 530–33.
- Weiner P, Ganam R, Ganem R, et al: Clinical course of recent onset atrial fibrillation treated with oral Propafenone. Chest 1994; 105: 1013–16.
- Ruffy R: Sotalol. J Cardiovasc Electrophysiol 1993; 4: 81–98.
- Crijns HJ, Van Gelder IC, and Lie KI: Benefits and risks of antiarrhythmics drug therapy after DC electrical cardioversion of atrial fibrillation or flutter. Eur Heart J 1994; 15 (Suppl A): 17.
- Sager PT: New advances in class III antiarrhythmics drug therapy. Curr Opin Cardiol 2000; 15: 41-53.
- Lim H, Hamaad A, Lip G. Clinical review: Clinical management of Atrial Fibrillation – rate control versus rhythm control. Clinical care 2004; 8(4): 271–9.
- UK Resuscitation Council. Advanced Life Support provider Manual (4th Edition) London: Resuscitation Council (UK) trading limited; 2004.
- Strasberg B, Sagie A, Rechavia E et al Deleterious effect of intravenous Verapamil in WPW patients and Atrial Fibrillation. Cardiovascular drug and therapy. 189; 2(6): 801–6.
- Pugh PJ, Spurrell P, Kamalvand K, et al. Sedation by physician with diazepam for DC cardioversion of atrial arrhythmias. Heart 2001; 86:572–3.
- Boodhoo L, Bordoli G, Mitchell A, et al. The safety and effectiveness of a nurse led cardioversion service under sedation. Heart 2004; 90: 1443–6.
- Likosky DS, Kaplan LR, Weintraub RM et al. Intraoperative and post operative variables associated with strokes following cardiac surgery. Heart Surgery Forum. 2004; 7(4): E271–E276.
- Maisel WH, Rawn JD, Stevenson WG. Atrial Fibrillation after cardiac surgery. Annals of Internal Medicine. 201; 135(120): 1061–73.
- DIBiasi P, Scrofani R, Paje A et al. Intravenous Amiodarone Versus Propafenone for atrial fibrillation and flutter after cardiac operation. European Journal of Cardiothoracic Surgery. 1995; 9(10): 587–91.
- Ryan TJ, Antman EM, Brooks NH. ACC/AHA guidelines for management of acute myocardial infraction: A report of the American College of Cardiology/American Heart association transposed on practice guidelines. Journal of American College of Cardiology. 196; 28: 1328–1428.
- Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham study. Stroke. 1991; 22(8): 983–8.
- Wolf PA, Mitchell JB, Baker CS et al. Impact of atrial fibrillation on mortality, stroke, and medical costs. Archives of Internal Medicine. 1998;158(3): 229–34.
