Atrial fibrillation secondary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

In patients with paroxysmal atrial fibrillation, or after conversion of persistent AF, dronedarone is a medication that may be used to decrease the need for hospitalization, and can be started as an outpatient therapy. It can not be given in patients with class IV heart failure, decompensated heart failure, or depressed left ventricular function. A permanent pacemaker is not recommended in patients who do not have another indication for placement of a pacemaker.

2011 ACCF/AHA/HRS Focused Updates Incorporated Into the 2006 Guidelines for the Management of Patients With Atrial Fibrillation (DO NOT EDIT) [1][2]

Preventing Hospitalization Due to Recurrent AF (DO NOT EDIT)[1][2]

Class III (Harm)
"1. Dronedarone should not be administered to patients with Class IV heart failure or patients who have had an episode of decompensated heart failure in the past 4 wks, especially if they have depressed LV function (LV ejection fraction ≤ 35%). (Level of Evidence: B)"
Class IIa
"1. Dronedarone is reasonable to decrease the need for hospitalization for cardiovascular events in patients with paroxysmal AF or after conversion of persistent AF. Dronedarone can be initiated during outpatient therapy. (Level of Evidence: B)"

Secondary Prevention with Pacing (DO NOT EDIT)[1][2]

Class III
"1. Permanent pacing is not indicated for the prevention of AF in patients without any other indication for pacemaker implantation. (Level of Evidence: B)"

Sources

References

  1. 1.0 1.1 1.2 1.3 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114 (7):e257-354. DOI:10.1161/CIRCULATIONAHA.106.177292 PMID: 16908781
  2. 2.0 2.1 2.2 2.3 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 123 (10):e269-367. DOI:10.1161/CIR.0b013e318214876d PMID: 21382897
  3. Estes NA, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS et al. (2008) ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation): developed in collaboration with the Heart Rhythm Society. Circulation 117 (8):1101-20. DOI:10.1161/CIRCULATIONAHA.107.187192 PMID: 18283199

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