Sandbox/Recurrent AF

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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.[1]

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
 
 
 


References

  1. January CT, Wann LS, Alpert JS, Calkins H, Cleveland JC, Cigarroa JE; et al. (2014). "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society". J Am Coll Cardiol. doi:10.1016/j.jacc.2014.03.021. PMID 24685668.


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