Sandbox/Recurrent AF

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Mugilan Poongkunran M.B.B.S [2]

Recurrent Atrial Fibrillation

Shown below is an algorithm depicting the management of patients with recurrent atrial fibrillation based on the 2014 ACCF/AHA/HRS Guideline for the Management of Patients With Atrial Fibrillation.

Abbreviations: AF: Atrial fibrillation; bpm: Beats per minute; DC: Direct current; EF: Ejection fraction; HR: Heart rate

Recurrent atrial fibrillation (Paroxysmal or persistent)

Asymptomatic

Symptomatic

❑ Identify the underlying etiology and treat accordingly ❑ Proceed with rate control strategy as shown below

❑ Identify the underlying etiology and treat accordingly ❑ Proceed with rate control strategy as shown below

Did the patient achieve heart rate control goal: ❑ Resting HR <110 bpm in asymptomatic and EF > 40% patients ❑ Resting HR <80 bpm in symptomatic and EF < 40% patients

Did the patient achieve heart rate control goal: ❑ Resting HR <110 bpm in asymptomatic and EF > 40% patients ❑ Resting HR <80 bpm in symptomatic and EF < 40% patients

Yes

No

No

Yes

❑ Initiate long term rate control strategy ❑ Proceed with anticoagulation strategy as shown below

❑ Proceed with the cardioversion strategy

❑ Proceed with the cardioversion strategy

❑ Initiate antiarrhythmic drug therapy for maintenance of sinus rhythm ❑ Proceed with anticoagulation strategy as shown below

Successful (sinus rhythm)

Unsuccessful (AF)

❑ Initiate antiarrhythmic drug therapy for maintenance of sinus rhythm ❑ Proceed with anticoagulation strategy as shown below

❑ Initiate long term rate control strategy ❑ Proceed with anticoagulation strategy as shown below ❑ Consider catheter ablation