From the Guidelines
Precipitants for new rapid atrial fibrillation (AF) include acute illness, surgery, alcohol consumption, stimulant use, electrolyte abnormalities, thyroid dysfunction, acute myocardial infarction, heart failure exacerbation, pulmonary embolism, and severe infections or sepsis, as identified in the most recent guidelines 1. These precipitants can cause AF through various mechanisms, including increased sympathetic tone, direct cardiac irritability, altered atrial refractoriness, and structural changes that create an arrhythmogenic substrate in the atria. Some key points to consider in managing AF include:
- Identifying and addressing reversible precipitants, such as correcting potassium and magnesium levels, treating hyperthyroidism, and reducing or abstaining from alcohol consumption 1.
- Managing underlying heart disease and comorbidities, such as hypertension, coronary artery disease, and heart failure 1.
- Using a patient-centered approach to management, including education and shared decision-making 1.
- Considering the use of antiarrhythmic medications, such as beta blockers, nondihydropyridine calcium channel blockers, and digoxin, to control the ventricular rate and prevent thromboembolism 1.
- Evaluating the need for anticoagulation therapy to prevent stroke and thromboembolism 1. Overall, the management of AF requires a comprehensive approach that takes into account the individual patient's underlying conditions, symptoms, and preferences, as well as the latest evidence-based guidelines 1.
From the Research
Precipitants for New Rapid Atrial Fibrillation (AF)
- Atrial fibrillation can be precipitated by heart failure with reduced ejection fraction and cardiomyopathy 2
- The coexistence of atrial fibrillation and heart failure is associated with worse outcomes, including an increased risk of stroke 2, 3
- Certain medications, such as calcium channel blockers, may be contraindicated in patients with heart failure with reduced ejection fraction and comorbid atrial fibrillation 4
- Hemodynamically unstable patients with atrial fibrillation require emergent cardioversion, irrespective of the chronicity of atrial fibrillation 5
- Guideline-medical therapy for heart failure can decrease the incidence of atrial fibrillation and the progression of atrial myopathy 3
Management of Atrial Fibrillation
- Current therapy for atrial fibrillation includes drug therapy, catheter ablation, cryoballoon ablation, left atrial appendage closure, and the maze procedure 6
- Catheter ablation has shown superiority in improving survival, quality of life, and ventricular function, and reducing heart failure hospitalizations compared to antiarrhythmic drugs and rate control therapies 2, 3
- Rhythm control preferentially through catheter ablation is recommended in properly selected patients with both heart failure and atrial fibrillation 3