Atrial fibrillation (AF) is a common supraventricular tachycardia.
The management of AF centers on rate and/or rhythm control and prevention of stroke.
Risk of thromboembolic stroke must be assessed in every patient with AF so that appropriate preventive measures can be implemented. Medication therapy management (MTM) providers should be familiar with risk assessment tools and strategies for stroke prevention.
Medications used for stroke prevention, rate control, and rhythm control in AF have many important drug interactions (eg, warfarin, amiodarone). MTM providers should be vigilant for drug interactions in patients with AF and, when possible, recommend alternative therapies for other disorders that minimize the risk of significant interactions.
INTRODUCTION TO ATRIAL FIBRILLATION
Atrial fibrillation (AF) is the most common supraventricular tachycardia seen in clinical practice.1 It is estimated that 6 million Americans were diagnosed with AF in 2010; this number is projected to double by the year 2030.2 Atrial flutter is less common than AF, yet the management is essentially the same. In general, the management of AF centers on rate and/or rhythm control and prevention of stroke. Table 14-1 lists risk factors for developing AF.
TABLE 14-1Risk Factors for AF |Favorite Table|Download (.pdf) TABLE 14-1 Risk Factors for AF
Standard risk factors
Valvular heart disease
Obstructive sleep apnea
Early-onset familial lone AF
Having one parent with AF
A first-degree relative with AF at age <65 years
Left ventricular hypertrophy
Left atrial enlargement
Increased left ventricular wall thickness
Decreased left ventricular fractional shortening
Mutations in genes coding for sodium and potassium channels, gap junction protein
Single-nucleotide polymorphism (SNP) in chromosomes 4q25, 16q22, 1q21
Increased C-reactive protein (CRP)
Increased B-type natriuretic peptide (BNP)
AF—irregularly, irregular heart rate, which may present as tachycardia (atrial rate of 400 to 600 beats per minute [bpm]; ventricular rate of 120 to 180 bpm); characterized by disorganized atrial activation
Acute AF—onset of AF within the last 48 hours
Nonvalvular AF—AF in the absence of rheumatic mitral stenosis, a mechanical or bioprosthetic heart valve, or mitral valve repair
Paroxysmal AF—AF that terminates spontaneously within 7 days
Permanent AF—AF that does not terminate, despite therapy with drugs or electrical cardioversion
Persistent AF—AF that lasts longer than 7 days and does not terminate spontaneously
Postoperative AF—AF that occurs 3 to 5 days after surgery; usually self-terminating
Recurrent AF—two or more AF episodes
The management of AF is the same, irrespective of the type of AF - except for postoperative AF, which typically is treated for only one month.