First-Diagnosed Atrial Fibrillation: When Combination Rate Control Has Not Achieved the Heart Rate Target
Clinical scenario
Atrial fibrillation that has not been diagnosed before — regardless of symptom status, temporal pattern, or duration — in a patient who is haemodynamically stable.
Previous treatment — goal not reached
An initial trial of combination rate control therapy was undertaken, targeting a resting heart rate below 110 b.p.m. This protocol applies when that heart rate target was not achieved.
Next clinical approach (partial overview)
The next step involves a cardioversion strategy for symptomatic persistent AF, applied according to criteria that consider whether sinus rhythm may restore spontaneously within a defined window — the complete regimen is in the full protocol.
Treatment goal
Spontaneous restoration of sinus rhythm within 48 hours.
References
- AF that has not been diagnosed before, regardless of symptom status, temporal pattern, or duration.
- Cardioversion of symptomatic persistent AF.
- Wait-and-see if sinus rhythm restores spontaneously <48 h.
- Cardioversion of AF (either electrical or pharmacological) should be considered in symptomatic patients with persistent AF as part of a rhythm control approach.
DOI: 10.1093/eurheartj/ehae176
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