Treatments for atrial fibrillation
| Treatment | Indications | Contraindications |
|---|---|---|
| Rate control | Asymptomatic atrial fibrillation and rhythm control not favored (elderly patient, long-standing atrial fibrillation, markedly enlarged left atrium) | Avoid calcium channel blockers in patients with heart failure |
| Electric cardioversion | Symptomatic atrial fibrillation New-onset atrial fibrillation Low risk of thromboembolism: (< 48 hours since onset of atrial fibrillation, or at least 3 weeks of anticoagulation, or transesophageal echocardiography to rule out thrombus) | No anticoagulation or inability to obtain transesophageal echocardiography |
| Antiarrhythmic medications | Younger patient High cardiovascular risk Heart failure Failure of rate control therapy | Avoid propafenone and flecainide in those with structural heart disease and coronary heart disease Avoid dronedarone in persistent atrial fibrillation and congestive heart failure Avoid sotalol and dofetilide in renal failure |
| Catheter ablation | Younger patients Symptomatic atrial fibrillation, refractory to medical therapy Can be considered in heart failure | Marked left atrial dilation |
| Atrioventricular junction ablation and cardiac resynchronization therapy | Contraindication to ablation or failure of ablation Permanent atrial fibrillation Systolic heart failure with ejection fraction < 30% | Frail patient Expected survival < 1 year |