Atrial fibrillation secondary prevention: Difference between revisions
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! style="background-color:#9b9b9b;" | Class | ! style="background-color:#9b9b9b;" | Class | ||
! style="background-color:#9b9b9b;" | Drug | ! style="background-color:#9b9b9b;" | Drug | ||
! style="background-color:#9b9b9b;" | | ! style="background-color:#9b9b9b;" | [[Atrial fibrillation]] recurrence | ||
! style="background-color:#9b9b9b;" | Mortality | ! style="background-color:#9b9b9b;" | [[mortality rate|Mortality]] | ||
|- | |- | ||
| colspan="4" style="background-color:#c0c0c0;" | I. Voltage-gated Na+ channel blockers | | colspan="4" style="background-color:#c0c0c0;" | I. Voltage-gated Na+ channel blockers | ||
|- | |- | ||
| Ia | | Ia | ||
| Quinidine | | [[Quinidine]] | ||
| style="color:#32cb00;" | 0.51 (0.40 to 0.64) | | style="color:#32cb00;" | 0.51 (0.40 to 0.64) | ||
| style="color:#cb0000;" | 2.26 (0.93 to 5.45) | | style="color:#cb0000;" | 2.26 (0.93 to 5.45) | ||
|- | |- | ||
| | | | ||
| Disopyramide | | [[Disopyramide]] | ||
| 0.52 (0.27 to 1.01) | | 0.52 (0.27 to 1.01) | ||
| style="color:#cb0000;" | 7.56 (0.47 to 122.66) | | style="color:#cb0000;" | 7.56 (0.47 to 122.66) | ||
|- | |- | ||
| rowspan="2" | Ic | | rowspan="2" | Ic | ||
| Flecainide | | [[Flecainide]] | ||
| style="color:#32cb00;" | 0.31 (0.16 to 0.60) | | style="color:#32cb00;" | 0.31 (0.16 to 0.60) | ||
| style="color:#32cb00;" | Unestimable as no deaths occurred | | style="color:#32cb00;" | Unestimable as no deaths occurred | ||
|- | |- | ||
| Propafenone | | [[Propafenone]] | ||
| style="color:#32cb00;" | 0.37 (0.28 to 0.48) | | style="color:#32cb00;" | 0.37 (0.28 to 0.48) | ||
| style="color:#32cb00;" | 0.05 (0.00 to 1.02) | | style="color:#32cb00;" | 0.05 (0.00 to 1.02) | ||
| Line 42: | Line 42: | ||
|- | |- | ||
| IIa | | IIa | ||
| Metoprolol | | [[Metoprolol]] | ||
| style="color:#32cb00;" | 0.62 (0.44 to 0.88) | | style="color:#32cb00;" | 0.62 (0.44 to 0.88) | ||
| 2.75 (0.39 to 19.6) | | 2.75 (0.39 to 19.6) | ||
| Line 49: | Line 49: | ||
|- | |- | ||
| rowspan="3" | IIIa | | rowspan="3" | IIIa | ||
| Amiodarone | | [[Amiodarone]] | ||
| style="color:#32cb00;" | 0.19 (0.14 to 027) | | style="color:#32cb00;" | 0.19 (0.14 to 027) | ||
| 1.64 (0.59 to 4.56) | | 1.64 (0.59 to 4.56) | ||
|- | |- | ||
| Dronedarone | | [[Dronedarone]] | ||
| style="color:#32cb00;" | 0.59 (0.46 to 0.75) | | style="color:#32cb00;" | 0.59 (0.46 to 0.75) | ||
| 0.85 (0.67 to 1.09) | | 0.85 (0.67 to 1.09) | ||
|- | |- | ||
| Sotalol | | [[Sotalol]] | ||
| style="color:#32cb00;" | 0.51 (0.43 to 0.60) | | style="color:#32cb00;" | 0.51 (0.43 to 0.60) | ||
| style="color:#cb0000;" | 2.23 (1.10 to 4.50) | | style="color:#cb0000;" | 2.23 (1.10 to 4.50) | ||
|} | |} | ||
In patients with [[paroxysmal atrial fibrillation]], a number of medications are available | In [[patients]] with [[paroxysmal atrial fibrillation]], a number of [[medications]] are available after conversion of persistent [[atrial fibrillation]] ([[AF]]). [[Dronedarone]] is a [[medication]] that may be used to decrease the need for [[hospital|hospitalization]], and can be started as [[patient|outpatient]] [[therapy]]. It can not be given in [[patients]] with class IV [[heart failure]], decompensated [[heart failure]], or depressed [[ventricle|left ventricular]] function. A [[Artificial pacemaker|permanent pacemaker]] is not recommended in [[patients]] who do not have another indication for placement of a [[pacemaker]] | ||
==="Pill-in-the-pocket" approach=== | ==="Pill-in-the-pocket" approach=== | ||
As needed [[flecainide]] or [[propafenone]] can be take orally according to [[clinical practice guideline]]s from 2014 by the [[American College of Cardiology]] and [[American Heart Association]]<ref name="pmid24685669">{{cite journal| author=January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC et al.| title=2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. | journal=J Am Coll Cardiol | year= 2014 | volume= 64 | issue= 21 | pages= e1-76 | pmid=24685669 | doi=10.1016/j.jacc.2014.03.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24685669 }} </ref> | *As needed [[flecainide]] or [[propafenone]] can be take [[mouth|orally]] according to [[clinical practice guideline]]s from 2014 by the [[American College of Cardiology]] and [[American Heart Association]].<ref name="pmid24685669">{{cite journal| author=January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC et al.| title=2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. | journal=J Am Coll Cardiol | year= 2014 | volume= 64 | issue= 21 | pages= e1-76 | pmid=24685669 | doi=10.1016/j.jacc.2014.03.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24685669 }} </ref> | ||
The guidelines, give a IIa recommendation after "observed to be safe in a monitored setting." The guidelines cite one [[randomized controlled trial]]<ref name="pmid15575054">{{cite journal| author=Alboni P, Botto GL, Baldi N, Luzi M, Russo V, Gianfranchi L et al.| title=Outpatient treatment of recent-onset atrial fibrillation with the "pill-in-the-pocket" approach. | journal=N Engl J Med | year= 2004 | volume= 351 | issue= 23 | pages= 2384-91 | pmid=15575054 | doi=10.1056/NEJMoa041233 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15575054 }} </ref>. In this trial, the dose was: | *The guidelines, give a IIa recommendation after "observed to be safe in a monitored setting." The guidelines cite one [[randomized controlled trial]].<ref name="pmid15575054">{{cite journal| author=Alboni P, Botto GL, Baldi N, Luzi M, Russo V, Gianfranchi L et al.| title=Outpatient treatment of recent-onset atrial fibrillation with the "pill-in-the-pocket" approach. | journal=N Engl J Med | year= 2004 | volume= 351 | issue= 23 | pages= 2384-91 | pmid=15575054 | doi=10.1056/NEJMoa041233 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15575054 }} </ref>. In this trial, the dose was: | ||
* Patient weighed less than 70 kg: [[flecainide]] 200 mg or [[propafenone]] was 450 mg | ** [[Patient]] weighed less than 70 kg: [[flecainide]] 200 mg or [[propafenone]] was 450 mg | ||
* patient weighed 70 kg or more: [[flecainide]] 300 mg or [[propafenone]] was 600 mg | ** [[patient]] weighed 70 kg or more: [[flecainide]] 300 mg or [[propafenone]] was 600 mg | ||
In the trials, the drug was first tested in a monitored setting: "After administration of the drug, heart rhythm was monitored for at least 8 hours, blood pressure was measured every 30 minutes with the use of a cuff, and a 12-lead electrocardiogram was recorded every hour."<ref name="pmid15575054"/> | *In the trials, the [[medication|drug]] was first tested in a monitored setting: "After administration of the [[medication|drug]], [[sinus rhythm|heart rhythm]] was monitored for at least 8 hours, [[blood pressure]] was measured every 30 minutes with the use of a cuff, and a 12-lead [[electrocardiogram]] was recorded every hour."<ref name="pmid15575054"/> | ||
==2011 ACCF/AHA/HRS Focused Updates Incorporated Into the 2006 Guidelines for the Management of Patients With Atrial Fibrillation (DO NOT EDIT) <ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.] ''Circulation'' 114 (7):e257-354. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref><ref name="pmid21382897">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21382897 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.] ''Circulation'' 123 (10):e269-367. [http://dx.doi.org/10.1161/CIR.0b013e318214876d DOI:10.1161/CIR.0b013e318214876d] PMID: [http://pubmed.gov/21382897 21382897]</ref>== | ==2011 ACCF/AHA/HRS Focused Updates Incorporated Into the 2006 Guidelines for the Management of Patients With Atrial Fibrillation (DO NOT EDIT) <ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.] ''Circulation'' 114 (7):e257-354. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref><ref name="pmid21382897">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21382897 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.] ''Circulation'' 123 (10):e269-367. [http://dx.doi.org/10.1161/CIR.0b013e318214876d DOI:10.1161/CIR.0b013e318214876d] PMID: [http://pubmed.gov/21382897 21382897]</ref>== | ||
Revision as of 20:37, 1 December 2021
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Resident Survival Guide |
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Atrial Fibrillation Microchapters | |
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Special Groups | |
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Diagnosis | |
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Treatment | |
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Cardioversion | |
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Anticoagulation | |
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Surgery | |
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Case Studies | |
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Atrial fibrillation secondary prevention On the Web | |
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Directions to Hospitals Treating Atrial fibrillation secondary prevention | |
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Risk calculators and risk factors for Atrial fibrillation secondary prevention | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2] Anahita Deylamsalehi, M.D.[3]
Overview
Secondary Prevention
| Class | Drug | Atrial fibrillation recurrence | Mortality |
|---|---|---|---|
| I. Voltage-gated Na+ channel blockers | |||
| Ia | Quinidine | 0.51 (0.40 to 0.64) | 2.26 (0.93 to 5.45) |
| Disopyramide | 0.52 (0.27 to 1.01) | 7.56 (0.47 to 122.66) | |
| Ic | Flecainide | 0.31 (0.16 to 0.60) | Unestimable as no deaths occurred |
| Propafenone | 0.37 (0.28 to 0.48) | 0.05 (0.00 to 1.02) | |
| II. Autonomic inhibitors and activators | |||
| IIa | Metoprolol | 0.62 (0.44 to 0.88) | 2.75 (0.39 to 19.6) |
| III. K+ channel blockers and openers | |||
| IIIa | Amiodarone | 0.19 (0.14 to 027) | 1.64 (0.59 to 4.56) |
| Dronedarone | 0.59 (0.46 to 0.75) | 0.85 (0.67 to 1.09) | |
| Sotalol | 0.51 (0.43 to 0.60) | 2.23 (1.10 to 4.50) | |
In patients with paroxysmal atrial fibrillation, a number of medications are available after conversion of persistent atrial fibrillation (AF). Dronedarone is a medication that may be used to decrease the need for hospitalization, and can be started as outpatient therapy. It can not be given in patients with class IV heart failure, decompensated heart failure, or depressed left ventricular function. A permanent pacemaker is not recommended in patients who do not have another indication for placement of a pacemaker
"Pill-in-the-pocket" approach
- As needed flecainide or propafenone can be take orally according to clinical practice guidelines from 2014 by the American College of Cardiology and American Heart Association.[2]
- The guidelines, give a IIa recommendation after "observed to be safe in a monitored setting." The guidelines cite one randomized controlled trial.[3]. In this trial, the dose was:
- Patient weighed less than 70 kg: flecainide 200 mg or propafenone was 450 mg
- patient weighed 70 kg or more: flecainide 300 mg or propafenone was 600 mg
- In the trials, the drug was first tested in a monitored setting: "After administration of the drug, heart rhythm was monitored for at least 8 hours, blood pressure was measured every 30 minutes with the use of a cuff, and a 12-lead electrocardiogram was recorded every hour."[3]
2011 ACCF/AHA/HRS Focused Updates Incorporated Into the 2006 Guidelines for the Management of Patients With Atrial Fibrillation (DO NOT EDIT) [4][5]
Preventing Hospitalization Due to Recurrent AF (DO NOT EDIT)[4][5]
| Class III (Harm) |
| "1. Dronedarone should not be administered to patients with Class IV heart failure or patients who have had an episode of decompensated heart failure in the past 4 wks, especially if they have depressed LV function (LV ejection fraction ≤ 35%). (Level of Evidence: B)" |
| Class IIa |
| "1. Dronedarone is reasonable to decrease the need for hospitalization for cardiovascular events in patients with paroxysmal AF or after conversion of persistent AF. Dronedarone can be initiated during outpatient therapy. (Level of Evidence: B)" |
Secondary Prevention with Pacing (DO NOT EDIT)[4][5]
| Class III |
| "1. Permanent pacing is not indicated for the prevention of AF in patients without any other indication for pacemaker implantation. (Level of Evidence: B)" |
Prevention of Bleeding
- It is critical to control any bleeding risk factor in patients who are receiving treatment for atrial fibrillation.[6]
- Based on NICE guideline the following interventions should be done in order to prevent bleeding:[6]
- Control uncontrolled hypertension
- Check INR properly in patients who are receiving vitamin K antagonists
- Control medication history of your patient (check for medications that can increase the risk of bleeding, such as selective serotonin reuptake inhibitor (SSRIs), Non-steroidal anti-inflammatory drugs (NSAIDs) and antiplatelet drugs)
- Ask patients to avoid excess alcohol drinking
- Treat anemia
Sources
- 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation [5]
- ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter [7]
References
- ↑ Lafuente-Lafuente C, Valembois L, Bergmann JF, Belmin J (2015). "Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation". Cochrane Database Syst Rev (3): CD005049. doi:10.1002/14651858.CD005049.pub4. PMID 25820938.
- ↑ January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC; et al. (2014). "2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society". J Am Coll Cardiol. 64 (21): e1–76. doi:10.1016/j.jacc.2014.03.022. PMID 24685669.
- ↑ 3.0 3.1 Alboni P, Botto GL, Baldi N, Luzi M, Russo V, Gianfranchi L; et al. (2004). "Outpatient treatment of recent-onset atrial fibrillation with the "pill-in-the-pocket" approach". N Engl J Med. 351 (23): 2384–91. doi:10.1056/NEJMoa041233. PMID 15575054.
- ↑ 4.0 4.1 4.2 4.3 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114 (7):e257-354. DOI:10.1161/CIRCULATIONAHA.106.177292 PMID: 16908781
- ↑ 5.0 5.1 5.2 5.3 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 123 (10):e269-367. DOI:10.1161/CIR.0b013e318214876d PMID: 21382897
- ↑ 6.0 6.1 Perry M, Kemmis Betty S, Downes N, Andrews N, Mackenzie S, Guideline Committee (2021). "Atrial fibrillation: diagnosis and management-summary of NICE guidance". BMJ. 373: n1150. doi:10.1136/bmj.n1150. PMID 34020968 Check
|pmid=value (help). - ↑ Estes NA, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS et al. (2008) ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation): developed in collaboration with the Heart Rhythm Society. Circulation 117 (8):1101-20. DOI:10.1161/CIRCULATIONAHA.107.187192 PMID: 18283199