Atrial fibrillation management

Expert opinion is a source, frequently elicited by survey, that is used to obtain information where no or few data are available. For example, in our experience with a multicountry evaluation of health care resource utilization in atrial fibrillation, very few country-specific published data were available on this subject. Thus the decision-analytic model was supplemented with data from a physician expert panel survey to determine initial management approach (rate control vs. cardioversion) first-, second-, and third-line agents doses and durations of therapy type and frequency of studies that would be performed to initiate and monitor therapy type and frequency of adverse events, by body system and the resources used to manage them place of treatment and adverse consequences of lack of atrial fibrillation control and cost of these consequences, for example, stroke, congestive heart failure. This method may also be used in testing the robustness of the analysis [30]. 

Management of Stable Atrial Fibrillation/Atrial Flutter... 

Snow V, Weiss KB, LeFevre M, et al. Management of newly detected atrial fibrillation a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians. Ann Intern Med 2003 139 1009-1017. 

The growth and spread of thyroid carcinoma is stimulated hy TSH. An important component of thyroid carcinoma management is the use ofLT4 to suppress TSH secretion. Early in therapy, patients receive the lowest LT4 dose sufficient to fully suppress TSH to undetectable levels. Controlled trials show that suppressive LT4 therapy reduces tumor growth and improves survival. These patients are purposefully overtreated with LT4 and rendered subclinically hyperthyroid. Postmenopausal women should receive aggressive osteoporosis therapy to prevent LT4-induced bone loss. Other thyrotoxic complications, such as atrial fibrillation, should be monitored and managed appropriately. 

Digoxin, prototype of the cardiac glycosides, is frequently used postoperatively for the management of atrial fibrillation. This effect is based on the impairment of AV conduction and unrelated to digoxin s positive inotropic activity. In the treatment of post-operative atrial fibrillation digoxin may be... 

Fuster V, Ryden EE, Cannon DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation executive summary. J Am CoU Cardiol 2006 48 854-906. 

Prystowsky EN, Benson DW, Fuster V, Hart RG, Kay GN, Myerburg RJ et al. Management of patients with atrial fibrillation. A Statement for Healthcare Professionals. From the Subcommittee on Electrocardiography and Electrophysiology, American Heart Association. Circulation 1996 93 1262-77. 

Management of hypothyroidism consists of identifying the underlying cause and then providing thyroid hormone replacement to normalize thyroid sta-ms. The goal of treatment is to reduce semm TSH levels to normal, which for most assays is roughly between 0.5 and 3 mU/1. Oversuppression of TSH levels is probably not advisable, as overtreatment may predispose to cardiac arrhythmias (particularly atrial fibrillation), and may have subtle effects on bone mineral density. 

Rapid loading dose for the management and treatment of CHF control ofventricular rate In patients with atrial fibrillation-, treatment and prevention of recurrent paroxysmal atrial tachycardia PO Initially, 0.5-0.75 mg, additional doses of 0.125-0.375 mg at 6-to8-hr intervals. Range 0.75-1.25 mg. IV 0.6-1 mg. 

Unlabeled Uses Conversion and management of atrial fibrillation... 

Disturbances of cardiac rhythm (e.g., tachycardia, atrial fibrillation, ventricular flutter, and A-V or intraventricular block) are the most frequent causes of death. Thus, management of cardiac function is critical. If the patient survives the early phase, recovery without sequelae is probable, and vigorous resuscitative measures are important. A major clinical problem is determining when a patient is no longer in danger. Many patients with mild overdose have been hospitalized... 

Clinicians from Hong Kong reported a case of potential danshen-warfarin interaction in a 48-year-old female with a history of rheumatic heart disease, atrial fibrillation, and mitral stenosis (11). The patient underwent successful transvenous mitral valvuloplasty for management of her medical conditions, and was discharged with 1 mg warfarin, as well as... 

Ventricular tachycardia, atrial fibrillation, and flutter (can convert recent-onset fibrillation or flutter to sinus rhythm). Amiodarone is used in the management of patients with supraventricular and ventricular arrhythmias, and arrhythmias associated with the WPW syndrome... 

Diltiazem appears to be similar in efficacy to verapamil in the management of supraventricular arrhythmias, including rate control in atrial fibrillation. An intravenous form of diltiazem is available for the latter indication and causes hypotension or bradyarrhythmias relatively... 

Fuster V et al ACC/AHA/ESC Guidelines for the management of patients with atrial fibrillation. Circulation 2006 114 700. 

Chatap G, Giraud K, Vincent JP Atrial fibrillation in the elderly Facts and management. Drugs Aging 2002 19 819. [PMID 12428993]... 

Atrial fibrillation modern concepts and management. Annu Rev Med. 2005 56 475-494. 

These agents appear to be similar in efficacy to verapamil in the management of supraventricular arrhythmias, including rate control in atrial fibrillation. An intravenous form of diltiazem is available for the latter indication and causes hypotension or bradyarrhythmias relatively infrequently. Bepridil also has action potential- and QT-prolonging actions that theoretically may make it more useful in some ventricular arrhythmias but also create the risk of torsade de pointes. Bepridil is only rarely used, primarily to control refractory angina. 

Albers GW. Stroke prevention in atrial fibrillation pooled analysis of SPORTIF III and V trials. Am J Manag Care 2004 ... 

McNamara RL, et al. Management of atrial fibrillation review of the evidence for the role of pharmacologic therapy, electrical cardioversion, and echocardiography. Ann Intern Med 2003 139(12) 1018-1033. 

Majeed A, Moser K, Carroll K. Trends in the prevalence and management of atrial fibrillation in general practice in England and Wales, I 994-1 998 analysis of data from the general practice research database, Heart 2001 86(3) 284—288. 

The Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Investigators (2002) N Engl J Med 347 1825... 

What are the two options in terms of treatment strategy that may be employed to manage atrial fibrillation Indicate what would be the most appropriate strategy that you could recommend to the doctor managing this patient and why you think this is the case. 

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