1. Atrial Fibrillation
Steven Podnos MD

2. Pathophysiology
• Most Common Arrythmia
• 5% of patients over 65yoa, increases with age
• Associated with
hypertension, cardiomyopathy, valvular
disease, ischemia, alcohol

3. Approach to Therapy
• Depends on severity and comorbid conditions
• Rate vs. Rhythm control
• Stroke prophylaxis

4. Rythym Control
• New Afib
• Symptomatic Afib
• Usually catheter ablation

5. Rate Control
• In absence of symptoms and combined with
appropriate stroke prophylaxis, equal outcome
to trying rhythm control.
• Pharmacologic/ Electrophysiology

6. CHADS2-stroke prophylaxis
• CHF
• Hypertension
• Age over 75
• Diabetes
• Stroke

7. Initial Approach
• Rate Control
• Anticoagulation
• Decision on Rhythm control efforts
• If not know to be in afib for less than 48
hours, need 3-4 weeks (or TEE)
anticoagulation before cardioversion

8. Rate Control
• Calcium Channel Blockers- not the “pines”
• Beta Blockers
• Digoxin-only limited benefit. Adjunctive if
coexistent LV dysfunction
• If drugs fail, catheter ablation

9. Rhythm Control
• For symptoms:
• Propafenone, Flecainide for normal heart
• Amiodarone/Multaq for systolic dysfunction
and afib
• Ablation

10. Anticoagulation
• Long Term for CHADS2 score over 1-2
• Coumadin vs. Pradaxa