af rate control
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TRI L FIBRILL TION
RATE CONTROL VS RHYTHM CONTROL
AF WORKSHOP 2014
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PERMANENT AF
AF that decided to be permanent
because
- cannot be terminated in what
means of treatment,
- low success or unlikely to achievesinus rhythm,
- failed cardioversion
- decided not to try cardioversion
- when the presence of the
arrhythmia is accepted by
the patient (and physician).
Usually long standing
Most have significant structural
heart disease.
Treatment strategy
RATE CONTROL
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PERSISTENT AF
AF episode either :
-lasts longer than 7 days
or-requires termination by
cardioversion - DRUGS
- DC SHOCK
Treatment strategy
PRIORITY : RATE CONTROL
Studies have shown no difference in term of
mortality outcome or rate stroke amongpatient with persistent AF converted to sinusrhythm vs rate controlled
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PERSISTENT AF
AF episode either :
-lasts longer than 7 days
or
-requires termination by
cardioversion - DRUGS
- DC SHOCK
Treatment strategy
RHYTHM CONTROL IF
Patient still symptomatic despite rate controlledYounger patientsThose presenting for the first time with lone AF
Those with AF secondary to a treated/correctedprecipitant
Those with persistent congestive heart failure.
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PAROXYSMAL AF
AF occurs and
terminates by itself
Usually resolves
spontaneously within 48hrs up to 7 days
TREATMENT STRATEGY
NO SYMPTOMS
NO RX
MINIMAL SYMPTOMS
RATE CONTROL
DISABLING SYMPTOMS
- RHYTHM CONTROL
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OPTIMAL RATE CONTROL
Priority is rate control first in most
cases
Decision for rhythm control depend on
physician & patients & certain
conditions
Previously aim of ventricular response:
rest : 60-80/min
moderate exercise : 90-115/min
Latest guideline : rest or exercise