RATE AND RYTHM CONTROL STRATEGY

RATE CONTROL STRATEGY

Most commonly used are beta-blockers which are more effective at rest
Also, nondihydropyridine calcium channel blockers (diltiazem and verapamil) which are effective both at rest and during exercise.
Digoxin is also used for sedentary patients and those with reduced left ventricular function.
Amiodarone can also be used, although rarely, if other agents have failed, are contraindicated, or for critically ill patients.
maintain a ventricular rate that protects the patient from the consequences of tachycardia.
Obtained by AV nodal conduction slowing drugs which aims to reach the initial target ventricular rate of <100 bpm (lenient rate) at rest.
If complaints persist despite lenient rate achievement, strict control should be done in which < 80 bpm at rest and < 110 bpm during moderate exercise

targets sinus rhythm restoration by pharmacological cardioversion (CV) antiarrhythmic drugs ± electrocardioversion and maintenance with antiarrhythmic drugs.
This is recommended for patients with paroxysmal or persistent AF in the presence of favorable clinical and echocardiographic parameters

involves delivery of an electric shock synchronized with intrinsic activity of the heart
performed with the patient in a fasting state and with adequate sedation for elective cases.
success of electrical CV depends on adequacy of delivered current flow and determinants such as nature of shock waveform and level of delivered energy
Initial requirement is ≥200 joules for monophasic and ≥100 joules for biphasic waveform
RISKS AND COMPLICATIONS
- Thromboembolic events
- Post-cardioversion arrhythmias
- Risks of general anesthesia
- Skin burns – common
- Hypoxia or hypoventilation
- Hypotension – rare
- Pulmonary edema – rare

considered as management for hemodynamically stable patients
requires continuous medical supervision and ECG monitoring during drug administration and for a period afterwards until drug elimination half-life