Fast Five Quiz: Key Aspects of Atrial Fibrillation

Yasmine S. Ali, MD

Disclosures

September 13, 2018

Ablation (catheter based, surgical, or hybrid) for AF can also be performed for achieving rhythm control. The ACC/AHA/HRS guidelines recommend catheter ablation in the following settings:

  • It is useful for patients with symptomatic paroxysmal AF who are intolerant of, or whose condition is refractory to, at least one class I or class III antiarrhythmic medication when a rhythm-control strategy is desired (class I, level of evidence [LOE]: A)

  • It is reasonable as a treatment for certain patients with symptomatic persistent AF who are intolerant of, or whose condition is refractory to, at least one class I or class III antiarrhythmic medication (class IIa, LOE: A)

  • It is a reasonable initial strategy for rhythm control prior to using antiarrhythmic drug therapy for patients with recurrent symptomatic paroxysmal AF (class IIa, LOE: B).

As patients with AF age, the relative efficacy of oral anticoagulation appears not to decrease, whereas the efficacy of antiplatelet therapy does appear to decrease.

In general, patients who develop AF only postoperatively do not need anticoagulation. Administration of preoperative and postoperative beta-blockers is usually sufficient, as postoperative AF is usually paroxysmal and tends to terminate spontaneously.

Dronedarone is structurally similar to amiodarone, but it lacks amiodarone's iodine moieties. Although the lack of iodine moieties reduces the incidence of adverse events, dronedarone is less effective for rhythm control than amiodarone. Dronedarone has been found to be associated with increased mortality in patients with permanent AF. The randomized, double-blind, phase III Permanent Atrial fibriLLation Outcome Study Using Dronedarone on Top of Standard Therapy (PALLAS) trial was halted following a preliminary review that revealed that dronedarone was associated with a twofold rise in risk for death. Twofold increases in two other endpoints, stroke and hospitalization for heart failure, were also noted when compared with placebo.

For more on treatment of AF, read here.

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