From the Guidelines
The current management of atrial fibrillation (AFib) should focus on a comprehensive approach including stroke prevention, rate or rhythm control, and addressing underlying causes, with an emphasis on lifestyle and risk factor modification as a pillar of AF management, as recommended by the 2023 ACC/AHA/ACCP/HRS guideline 1.
Key Components of AFib Management
- Stroke prevention typically involves anticoagulation with direct oral anticoagulants (DOACs) such as apixaban, rivaroxaban, dabigatran, or edoxaban, which are preferred over warfarin for most patients.
- Rate control medications include beta-blockers, calcium channel blockers, or digoxin, with a lenient target heart rate (<110 beats/min at rest) as initial therapy.
- For rhythm control, antiarrhythmic drugs like amiodarone, flecainide, propafenone, or sotalol may be used, with catheter ablation recommended for symptomatic patients who fail or cannot tolerate medication, particularly those with heart failure with reduced ejection fraction 1.
Risk Factor Modification and Prevention
- The management of AFib should recognize lifestyle and risk factor modification as a crucial aspect, including management of obesity, weight loss, physical activity, smoking cessation, alcohol moderation, hypertension, and other comorbidities 1.
- The CHA₂DS₂-VASc score guides anticoagulation decisions, with scores ≥2 in men or ≥3 in women generally warranting anticoagulation, and consideration of other risk variables and clinical risk scores to inform decision-making 1.
Treatment Approach
- The treatment approach varies based on whether AFib is paroxysmal, persistent, or permanent, with the goals of improving symptoms, preventing complications, and enhancing quality of life.
- Early rhythm control and catheter ablation are emphasized as important strategies in the management of AFib, particularly in selected patients and those with heart failure with reduced ejection fraction 1.
From the FDA Drug Label
Sotalol AF are indicated for the maintenance of normal sinus rhythm [delay in time to recurrence of atrial fibrillation/atrial flutter (AFIB/AFL)] in patients with symptomatic AFIB/AFL who are currently in sinus rhythm. Patients with atrial fibrillation should be anticoagulated according to usual medical practice.
The current management of atrial fibrillation (afib) includes:
- Maintenance of normal sinus rhythm using medications like Sotalol AF
- Anticoagulation according to usual medical practice to prevent stroke and other complications
- Monitoring of patients, especially during initiation and titration of therapy, to prevent serious ventricular arrhythmias 2
- Individualized treatment based on patient's creatinine clearance and QT interval 2
- Reservation of Sotalol AF for patients with highly symptomatic AFIB/AFL 2
From the Research
Current Management of Atrial Fibrillation
The current management of atrial fibrillation (AF) includes various treatment options, such as:
- Drug therapy 3
- Catheter ablation 3, 4
- Cryoballoon ablation 3
- Left atrial appendage closure 3
- The maze procedure 3
- Rhythm control versus heart rate control 4
- Stroke prevention therapy, including anticoagulation options 4, 5, 6, 7
Treatment Strategies
Treatment strategies for AF may vary depending on the patient's condition and risk factors, including:
- Selection of rhythm control versus heart rate control 4
- Use of the CHA2DS2-Vasc score for stroke risk assessment 4
- Expansion of anticoagulation options in selected patients 4
- Decreased emphasis on the role of aspirin 4
- Increased emphasis on the role of catheter ablation 4, 5
Clinical Practice
Current clinical practice among European Heart Rhythm Association (EHRA) community includes:
- Atrial fibrillation screening in high-risk patients 5
- Use of direct oral anticoagulants as the preferred antithrombotic 5
- Rhythm control as the preferred strategy in most AF phenotypes 5
- Ablation as the first-line therapy for symptomatic paroxysmal AF and persistent AF with markers of atrial disease 5
Integrated Care Models
Integrated care models that provide patient-centred care in, or close to, the patient's community while maintaining access to all specialist treatment options, emerge as the best approach to achieve consistent delivery of chronic treatments to all patients with AF 6.