From the Research
The recommended length of hospital stay for monitoring rate control of atrial fibrillation is typically 24-48 hours, as supported by the most recent study 1. This duration may vary based on individual patient factors, such as comorbidities, hemodynamic instability, or the need for additional interventions like cardioversion. The primary goal of hospitalization is to achieve adequate rate control, usually defined as a ventricular rate below 100 beats per minute at rest, and to ensure hemodynamic stability. Key considerations for rate control include:
- Initial rate control is commonly achieved using medications such as metoprolol, diltiazem, or digoxin.
- Beta blockers (BB) have been found to be more potent for rapid reduction of the heart rate compared to calcium channel blockers (CCB) and demonstrated better efficiency in shortening the duration of hospitalization in a subgroup of patients 1.
- The choice of medication depends on patient characteristics, with stricter targets recommended for patients with compromised functional capacity, such as those with heart failure. Some important points to consider when managing atrial fibrillation include:
- The aim of rate control is not only to reduce the heart rate but also to improve patient wellbeing, exercise tolerance, symptoms, and quality of life 2.
- Continuous monitoring of AF and ventricular rate during AF by implantable devices is the most comprehensive method for assessment of AF occurrence and poor rate control, particularly in patients with paroxysmal and asymptomatic AF 3.
- Understanding the nuances of rate control when treating individual patients and interpreting existing evidence allows patients to experience the most benefit from this treatment strategy 2. In patients with concomitant heart failure with a reduced ejection fraction (HFrEF), the use of IV diltiazem or metoprolol in the ED has been compared, with no difference in total adverse events, but a higher incidence of worsening CHF symptoms in the diltiazem group 4. Overall, the management of atrial fibrillation requires a personalized approach, taking into account the individual patient's characteristics, symptoms, and clinical characteristics.