Paroxysmal Atrial Fibrillation (PAF)
We agree with the recommendations in the Centre for Clinical Effectiveness document on management of Paroxsymal AF.
The European Society of Cardiology proffer:
No or minimal heart disease
- First therapeutic intervention should be either a Β-blocker or a class 1C antiarrhythmic drug
- Β-blockers are relatively ineffective in these circumstances but have the advantage of being well tolerated.
- Class 1C antiarrhythmics have the highest reported success rate of preventing PAF.
- If class 1C and Β-blockers fail, the class III agent, Amiodarone, should be the next
- When amiodarone fails or is inappropriate, then ablation with rate control or pacing should be considered.
Presence of heart disease
- Management is much more difficult.
- Class 1C antiarrhythmic drugs are not recommended (pro-arrhythmic).
- For some, Β-blockers may be worth a trial
- For many the class III agent Amiodarone will be the drug of choice.
Thromboembolism
- In all categories, there is a risk of thromboembolism.
- The antiarrhythmic strategy must be allied with consideration of the thromboembolic risk.
- In situations of moderate to high risk, oral Warfarin is appropriate.
- In very low risk circumstances, Aspirin may be the appropriate alternative.
- Please refer to the algorithm as suggested by the European Society of Cardiology.
