What is the treatment for atrial fibrillation (AFib)?

From the Guidelines

Treatment for atrial fibrillation (A-fib) should prioritize rate control with medications such as beta-blockers, calcium channel blockers, or digoxin, as recommended by the 2024 ESC guidelines 1. The primary goal of treatment is to control the heart rate and reduce symptoms, with beta-blockers, diltiazem, verapamil, or digoxin being recommended as first-choice drugs in patients with A-fib and left ventricular ejection fraction (LVEF) >40% 1. Key considerations for treatment include:

• Rate control therapy is recommended in patients with A-fib, as initial therapy in the acute setting, an adjunct to rhythm control therapies, or as a sole treatment strategy to control heart rate and reduce symptoms 1.
• Beta-blockers and/or digoxin are recommended in patients with A-fib and LVEF ≤40% to control heart rate and reduce symptoms 1.
• Stroke prevention is crucial, and anticoagulation therapy should be initiated in all patients with documented A-fib/atrial flutter who have an increased risk of stroke, as recommended by the 2016 ESC guidelines 1.
• Lifestyle modifications, such as reducing alcohol intake, managing sleep apnea, controlling blood pressure, and maintaining a healthy weight, are also important for managing A-fib. The 2024 ESC guidelines provide the most recent and highest-quality evidence for the management of A-fib, and should be prioritized in clinical decision-making 1.

From the FDA Drug Label

Apixaban was superior to warfarin for the primary endpoint of reducing the risk of stroke and systemic embolism (Table 9 and Figure 4). Superiority to warfarin was primarily attributable to a reduction in hemorrhagic stroke and ischemic strokes with hemorrhagic conversion compared to warfarin. Apixaban tablets are a prescription medicine used to: • reduce the risk of stroke and blood clots in people who have atrial fibrillation

Treatment for Atrial Fibrillation (AFib):

• Apixaban is used to reduce the risk of stroke and blood clots in people with AFib.
• The medication has been shown to be superior to warfarin in reducing the risk of stroke and systemic embolism.
• Apixaban works by preventing clots from forming in the heart, which can travel to the brain and cause a stroke.
• It is essential to take apixaban as directed by your doctor and not stop taking it without consulting them, as this can increase the risk of forming a clot in your blood 2, 2, 2.

From the Research

Treatment Options for Atrial Fibrillation

• Rate control is the preferred management option in most patients, with a goal of achieving a resting heart rate of less than 80 beats per minute 3
• Rhythm control is an option for patients in whom rate control cannot be achieved or who have persistent symptoms despite rate control 3
• Anticoagulation therapy is needed with rate control and rhythm control to prevent stroke, with warfarin being superior to aspirin and clopidogrel in preventing stroke 3
• Surgical options for atrial fibrillation include disruption of abnormal conduction pathways in the atria, and obliteration of the left atrial appendage 3
• Catheter ablation is an option for restoring normal sinus rhythm in patients with paroxysmal atrial fibrillation and normal left atrial size 3, 4

Non-Pharmacological Interventions

• Risk factor modification, including weight loss and treatment of hypertension, diabetes, and obstructive sleep apnea can reduce atrial fibrillation episodes 4
• Electrical cardioversion may be appropriate as first-line rhythm control 5
• Conversion to sinus rhythm with catheter ablation may be considered in patients who are unable or unwilling to take rate or rhythm control medications long-term or if medications have been ineffective 5

Pharmacological Interventions

• Anti-arrhythmic drugs (AADs) can be employed safely and effectively in certain patients, with a tailored approach being the way to propose the right treatment to the right patient 6
• Rate control is usually achieved with a β-blocker or non-dihydropyridine calcium channel blockers 4
• Maintenance of sinus rhythm with drugs or catheter ablation should be considered based on the individual needs of each patient 4

Assessment and Evaluation

• Stroke risk should be assessed in patients with atrial fibrillation using the CHA2DS2-VASc score 5
• The initial evaluation should include transthoracic echocardiography; serum electrolyte levels; complete blood count; and thyroid, kidney, and liver function tests 5
• Tools that predict the risk of stroke (e.g., CHADS2) and the risk of bleeding (e.g., Outpatient Bleeding Risk Index) are helpful in making decisions about anticoagulation therapy 3