Atrial Fibrillation Pathway - Rate Control
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.
If heart rate is > 110 beats/min despite maximal tolerated therapy, refer to Cardiology Department.
NOTE * Sotalol Warning:
1% risk of ventricular arrhythmias - higher risk elderly patients,patient with structual heart disease, patients with renal impairment.
Other Therapies for AF
AF ablation - pulmonary vein isolation:
- Is a highly complex procedure quite distinct from other rhythm ablation techniques.
- Has a higher risk of complications (3% chance of major complication including fatal atrio-oesophageal fistula).
AV nodal ablation with permanent pacemaker implantation:
- Can be considered in patients with significant ongoing AF control issues despite maximum medical therapy.
- This procedure renders a patient fully pacemaker dependent.
Rate control medications used in atrial fibrillation
Last updated : Friday, August 21, 2015
Next review date : Saturday, August 20,2016
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