Treatment of Atrial Fibrillation in Permanent Atrial Fibrillation
This protocol applies to patients with permanent atrial fibrillation — AF for which no further attempts at restoration of sinus rhythm are planned, following a shared decision between the patient and physician.
Once sinus rhythm restoration is no longer the goal, management is directed entirely at controlling the ventricular rate to reduce symptoms.
Rate control is initiated with a single agent, with the choice of agent determined by the patient's left ventricular function. The full protocol specifies which agents apply to each clinical subset and under what circumstances a procedural intervention becomes indicated — that detail is available in the complete regimen below.
The initial rate control target is a resting heart rate of <110 b.p.m. (lenient control), with stricter control reserved for patients with continuing symptoms.
References
DOI: 10.1093/eurheartj/ehae176AF for which no further attempts at restoration of sinus rhythm are planned, after a shared decision between the patient and physician.
Beta-blockers and/or digoxin are recommended in patients with AF and LVEF ≤40% to control heart rate and reduce symptoms.
Beta-blockers, diltiazem, verapamil, or digoxin are recommended as first-choice drugs in patients with AF and LVEF >40% to control heart rate and reduce symptoms.
Atrioventricular node ablation combined with cardiac resynchronization therapy should be considered in severely symptomatic patients with permanent AF and at least one hospitalization for HF to reduce symptoms, physical limitations, recurrent HF hospitalization, and mortality.
Lenient rate control with a resting heart rate of < 110 b.p.m. should be considered as the initial target for patients with AF, with stricter control reserved for those with continuing AF-related symptoms.
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