The goal of treating patients with atrial fibrillation is to decrease symptoms and prevent complications, especially stroke. All patients should be evaluated for their risk of stroke and blood clots.
Symptoms
- Symptom of atrial fibrillation.
- Fatigue: Feeling tired or weak, even with normal activities.
- Shortness of breath: Difficulty breathing or feeling like you can’t catch your breath, especially during physical activity.
- Dizziness or lightheadedness: Feeling faint or dizzy, which can occur when the heart is beating irregularly.
- Chest pain or discomfort: A sensation of pressure or tightness in the chest, which can occur in some cases of atrial fibrillation.
- Confusion or memory problems: Difficulty focusing or thinking clearly, which can occur when the brain is not getting enough oxygen-rich blood due to the irregular heartbeat.
Types of AF
- Paroxysmal symptoms stop within 48 hours without treatment (patients with symptomatic infrequent episodes “pill-in pocket” management can be used using flecainide, beta blocker or a calcium channel blocker.
- Persistent AF: Episodes last longer than a week
- Permanent AF: Longterm condition
management
There are two main ways to manage atrial fibrillation:
- Controlling the heart rate (rate control)- arrhythmia less than 48 hours or
- Trying to restore and maintain a regular heart rhythm (rhythm control)- arrhythmia longer than 48 hours
If initial treatment is not effective, patients should be referred for specialised care within four weeks. In cases where medication does not work or is not appropriate, ablation procedures can be considered.
Stroke risk
Tool used to assess stroke risk and bleeding risk
- Stroke risk: CHA2DS2- VASc (factors used age, sex, and prior history of congestive heart failure, hypertension, stroke, transient ischaemic attacks (TIA), thromboembolic events, vascular disease, or diabetes mellitus.
- Bleeding risk: ORBIT