True regarding atrial fibrillation:
a. ↑Thromboembolismb. Digoxin treatment
c.Anticoagulant not required
d.Aspirin given
e. Often fatal
Ans:
(A) ↑Thromboembolism; (B) Digoxin treatment; (D) Aspirin given
• The morbidity in atrial
fibrillation is due to:
·
Systemic embolisation
·
Excessive ventricular rate leads to hypotension, pulmonary
congestion or angina pectoris, tachycardia induced cardiomyopathy.
·
Syncope
·
Fatigue
·
Anxiety secondary to palpitation.
Treatment of atrial fibrillation
• Treatment of precipitating factors e.g. Fever, pneumonia,
alcoholic intoxications, thyrotoxicosis, pulmonary emboli, CUF or pericarditis.
• Rate control drugs: Beta-blockers, calcium channel
blockers and digoxin.
• Rhythm control drugs (only modestly effective to restore
sinus rhythm) : Class IA (e.g. Quinidine) or Flecainide like agents (class IC),
Amiodarone, Ibutilide / DcSfetilide, Sotalol etc.
• DC cardio
version — when clinical states severely compromised. It is highly effective to
restore sinus rhythm, either as primary treatment or following failure of
anti-arrhythmic therapy.
• Chronic anticoagulation particularly in elderly and if
associated with high risk of stroke in patients with atrial fibrillation.
Anti-coagulation is done with aspirin or warfarin.
• Ablation therapy for cure of AF generally applied for
paroxysmal AF e g Maze procedure
