This protocol addresses tachycardia-induced cardiomyopathy presenting in the context of atrial fibrillation complicated by decompensated heart failure — a combination that calls for a carefully chosen initial management strategy.
In decompensated heart failure with atrial fibrillation, heart rate control is generally recommended as the initial treatment strategy. The high recurrence rate of atrial fibrillation following cardioversion in this setting makes rate control the preferred first step.
Heart rate control is the recommended initial intervention in this scenario. The full protocol specifies the preferred pharmacological agent — selected after an important pre-treatment evaluation — along with the complete management algorithm.
DOI: 10.4070/kcj.2019.0199
In case of decompensated HF with AF, it is generally recommended to begin with a heart rate-control treatment because recurrence rate of AF following cardioversion is common.
In our experience, digoxin is a preferred choice for the initial rate control after excluding coronary artery disease.
Until then, a resting heart rate of up to 80 beats/min and up to 115 beats/min during moderate exercise should be an acceptable rate control target for AF patients with possible diagnosis of T-CMP.
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