Atrial Fibrillation Pathway - Criteria For Rate Control Management
Rate control and cardiac OPD assessment
Consider rate control therapy in all patients with AF:
- Ideally reduce heart rate to <80 beats/min.
- In some patients this will not be easily achieved and a rate between 80 and 110 may be acceptable.
- It may be helpful to check heart rate after gentle exercise.
Medications - all can be used alone or in combination except B blockers + verapamil:
- B-blockers - metoprolol and atenolol.
- Do not use sotalol due to the risk of ventricular arrhythmias.
- Calcium channel blockers e.g. diltiazem or verapamil.
- Digoxin - usually second line except in chronic heart failure when 1st line - has a role in sedate or hypotensive patients.
In addition to rate control, refer the following patients
- <65 years olds.
- Symptomatic especially dyspnoea.
- Suspected valvular heart disease.
- Suspected coronary artery disease.
- Isolated and principal problem (as 10% people >80 have AF consider referral to HIA where AF is one of a number of problems in an elderly patient).
Last updated : Friday, August 21, 2015
Next review date : Saturday, August 20,2016
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