💓 Atrial Fibrillation Rate/Rhythm Control Strategy
This tool gives rate-control targets/drugs, rhythm-control direction, and cardioversion anticoagulation for atrial fibrillation, branching first on hemodynamic stability.
Atrial Fibrillation Rate/Rhythm Control Strategy
Hemodynamics
Left ventricular ejection fraction
Symptomatic / comorbid HF / newly diagnosed early
Pre-excitation syndrome
AF duration (when planning cardioversion)
When to use
Use to manage AF: unstable patients get emergency cardioversion, while stable patients are guided to rate or rhythm control by LVEF, symptoms, and AF duration.
How it works
Unstable → emergency synchronized cardioversion. Stable → rate control (resting < 110, drug by LVEF) ± early rhythm control if symptomatic/HF/new; cardioversion anticoagulation by AF duration (3 weeks pre + 4 weeks post if ≥ 48 h, or TEE-guided).
Key points
- In pre-excitation with rapid AF, digitalis, non-dihydropyridine CCB, and amiodarone are avoided and the patient is cardioverted directly. (original synthesis · not guideline verbatim)
- Symptomatic, comorbid-HF, or newly diagnosed patients benefit from early rhythm control (EAST-AFNET 4).
- At LVEF ≤ 40%, non-dihydropyridine CCBs are contraindicated; rate control uses β-blocker ± digitalis.
References
- Van Gelder IC, et al. 2024 ESC Guidelines for the management of atrial fibrillation. Eur Heart J 2024.
- Kirchhof P, et al. Early Rhythm-Control Therapy in Patients with Atrial Fibrillation (EAST-AFNET 4). N Engl J Med 2020.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.