Permanent atrial fibrillation is a type of AF where restoring and maintaining normal heart rhythm (sinus rhythm) is no longer attempted or has failed. The main goals of treatment are to control symptoms, prevent complications (especially stroke), and improve quality of life.
Key Treatment Strategies:
- Rate Control: Medications are used to slow the heart rate, helping the heart work more efficiently. Usually <110 bpm at rest (lenient control), or <80 bpm (strict) if symptomatic. Common drugs include beta-blockers, calcium channel blockers, and digoxin.
- Anticoagulation: Based on CHA₂DS₂-VASc score. Blood thinners (such as warfarin or direct oral anticoagulants like rivaroxaban) are prescribed to reduce the risk of stroke, which is significantly increased in AF.
- Management of Risk Factors: This includes controlling blood pressure, diabetes, and other chronic conditions (e.g., hypertension, sleep apnea, hyperthyroidism), along with lifestyle changes such as diet, exercise, and stress management.
- Procedures: In some cases, especially if medications are not effective or tolerated, procedures like left atrial appendage occlusion devices may be considered to lower stroke risk for those who cannot take blood thinners. Consider AV nodal ablation and a pacemaker in refractory cases.
- Rhythm Control: For permanent AF, rhythm control (restoring normal rhythm) is generally not pursued, but may be considered in select cases or if symptoms are severe and other treatments fail.
Summary Table
| Goal | Approach |
|---|---|
| Control heart rate | Beta-blockers, calcium channel blockers, digoxin |
| Prevent stroke | Anticoagulants (warfarin, rivaroxaban, etc.) |
| Manage symptoms | Lifestyle changes, treat underlying conditions |
| Alternative stroke prevention | Left atrial appendage occlusion device |
Treatment is individualised based on age, symptoms, risk factors, and other health conditions. Regular follow-up with a cardiologist is essential for anticoagulation efficacy, HR control, symptom status, and structural heart changes.
Citations:
- https://my.clevelandclinic.org/health/diseases/23446-persistent-atrial-fibrillation
- https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/diagnosis-treatment/drc-20350630
- https://emedicine.medscape.com/article/151066-treatment
- https://pmc.ncbi.nlm.nih.gov/articles/PMC3872084/
- https://www.healthline.com/health/atrial-fibrillation/persistent
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