Atrial fibrillation is the most common arrhythmia and increases in prevalence with age. It is associated with conditions like hypertension, cardiomyopathy, and valvular disease. Treatment depends on severity and comorbidities, and involves rate or rhythm control as well as stroke prophylaxis. For new or symptomatic atrial fibrillation, rhythm control like catheter ablation may be used, while rate control with medications or procedures is sufficient for asymptomatic cases combined with anticoagulation. Stroke risk is assessed using the CHADS2 score, and long-term anticoagulation is recommended for scores over 1-2 to prevent stroke. Initial treatment often involves rate control, anticoagulation, and a decision on

1. Atrial Fibrillation
Steven Podnos MD

2. Pathophysiology
• Most Common Arrythmia
• 5% of patients over 65yoa, increases with age
• Associated with
hypertension, cardiomyopathy, valvular
disease, ischemia, alcohol

3. Approach to Therapy
• Depends on severity and comorbid conditions
• Rate vs. Rhythm control
• Stroke prophylaxis

4. Rythym Control
• New Afib
• Symptomatic Afib
• Usually catheter ablation

5. Rate Control
• In absence of symptoms and combined with
appropriate stroke prophylaxis, equal outcome
to trying rhythm control.
• Pharmacologic/ Electrophysiology

6. CHADS2-stroke prophylaxis
• CHF
• Hypertension
• Age over 75
• Diabetes
• Stroke

7. Initial Approach
• Rate Control
• Anticoagulation
• Decision on Rhythm control efforts
• If not know to be in afib for less than 48
hours, need 3-4 weeks (or TEE)
anticoagulation before cardioversion

8. Rate Control
• Calcium Channel Blockers- not the “pines”
• Beta Blockers
• Digoxin-only limited benefit. Adjunctive if
coexistent LV dysfunction
• If drugs fail, catheter ablation

9. Rhythm Control
• For symptoms:
• Propafenone, Flecainide for normal heart
• Amiodarone/Multaq for systolic dysfunction
and afib
• Ablation

10. Anticoagulation
• Long Term for CHADS2 score over 1-2
• Coumadin vs. Pradaxa