Management of atrial fibrillation

For patients who achieve sinus rhythm, there are several choices of antiarrhythmic agent to be considered for a rhythm-control strategy, including amiodarone, dofetilide, dronedarone, flecainide, propafenone, and sotalol. It is important to note that these medications are reasonable to continue even if the patient experiences episodes of AF, if the medication decreases the number of episodes or the symptoms associated with them. These medications should be stopped, however, if AF becomes permanent.

The bottom line

Atrial fibrillation is a common rhythm disorder that requires ongoing management of thromboembolic risk as well as adherence to either a rate-control or rhythm-control strategy. The choice for anticoagulation should be made jointly between the patient and physician, and should be based on the CHA2DS2-VASc score.

Reference

2014 AHA/ACC/HRS Guideline 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 Heart Rhythm Society (Circulation 2014 March 28 [doi: 10.1161/CIR.0000000000000040]).

Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. Dr. George-Reichley is a third-year resident in the family medicine residency program at Abington Memorial Hospital.