Therapy

According to the current guidelines of the European Society of Cardiology (ESC), management of AF consists of

1. adequate antithrombotic therapy by either continuous therapy with vitamin K antagonists (INR 2-3) or by approved novel anticoagulants such as thrombin inhibitors or factor Xa inhibitors.

2. In patients with AF, ventricular rate should be well controlled. This is usually achieved by a resting heart rate of 80 – 100 bpm and an adequate ventricular rate increase upon moderate exertion. Newer data indicate that patients who do not suffer much from the arrhythmia can be managed by a more lenient rate control approach (heart rate < 100 bpm). An inadequately controlled ventricular rate should be reduced by AV nodal slowing agents.

3. Furthermore, the recommendations regarding reduction of cardiovascular risk factors should be carefully followed. This includes management of hypertension, diabetes mellitus, vascular heart disease, and heart failure, among others.

4. In patients who remain symptomatic despite optimal rate control, rhythm control therapy should be considered. The present management options are moderately effective, but can prevent recurrent AF in some patients. They include antiarrhythmic drug therapy by ion channel blocking drugs and catheter ablation in the left atrium, usually by pulmonary vein isolation.