Evidence-based On-call

Atrial fibrillation

Prevalence
Causes
Clinical features
Investigations
Therapy
Prevention
Prognosis

Prevention

Anticoagulate patients who remain in or are at risk of relapsing back into atrial fibrillation ^a

For patients with one or more other risk factors for stroke ^a give warfarin adjusted ^a so INR 2.0 to 3.0 ^a ^b

See anticoagulation chapter for more details on warfarin therapy.

For patients at low-risk of stroke (<1% per year), at high-risk for a major bleed, or who particularly dislike the thought of taking warfarin ^a give aspirin

See anticoagulation chapter for more details on calculating your patient's risk of bleeding.

Paroxysmal atrial fibrillation

Consider long-term anti-arrhythmic therapy in symptomatic cases ^d

Start medication in hospital ^c

Consider using one of:

amiodarone ^a
flecainide - at least 100 mg twice daily
propafenone ^a 600 mg ^a daily by mouth
sotalol - at least 120 mg twice daily ^a
disopyramide ^a

There is no clear benefit from digoxin

Avoid using quinidine ^a

For patients with intolerable paroxysmal AF resistant to antiarrhythmic medication, consider

ablation of AV node and insertion of a DDDR permanent pacemaker ^a
an implantable atrial defibrillator ^c

Expiry date: February 2003
Levels of Evidence used in grading these guides

Authors	CM Ball , N Shenker
Reviewer	R G Hart
CAT Writers	CM Ball , N Shenker , CJ Wotton