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Atrial Fibrillation patients have over 50% higher mortality risk than the general population.1
Early management improves clinical outcomes.2
Uncontrolled Atrial Fibrillation (AF) should be referred to an Electrophysiologist
Diagram 1 - Simplified Patient Pathway 1- adapted from NICE guidance
Overview
Early Cardiology referral has been evidenced to improve clinical outcomes2. First-line treatment focuses on the use of anti-arrhythmic Drugs (AADs) or anticoagulants to control heart rate and rhythm, however this does not improve symptoms in all AF patients. Referral to cardiology and Electrophysiologists (Eps) is essential in patients who are unresponsive to initial treatment, present with severe symptoms such as HF, or those who are not tolerating anti-arrhythmic drugs well. Cardiology and EPs are able to utilise other treatment options such as ablation to improve symptoms.
PATIENTS WITH AF HAVE AN INCREASED RISK OF LIFE-THREATENING COMPLICATIONS AND OTHER DISEASES1:
20–30% of all strokes occur in people with Atrial Fibrillation.9
Stroke as a complications of AF is associated with long-term disability and mortality.10
AF Patients have a 142% increased risk of any stroke and a 133% greater risk of ischemic stroke9
Electrophysiologists
Early Cardiology referral has been evidenced to improve clinical outcomes11. Electrophysiologists (EPs) are a subspecialist group of cardiology, growing in size and popularity more recently, specifically interested in Heart Rhythm Management, focussing on AF, Bradycardia and other cardiac arrhythmias or electrical circuitry pathologies. Referral to Cardiology and EPs is essential in patients who are unresponsive to initial treatment, present with severe symptoms such as HF or those who are not tolerating antiarrhythmic drugs well. EPs can offer a range of treatment, including ablation which is evidenced to improve symptoms with fewer side effects.11
Optimal Referral Pathway
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Diagram 2- adapted from Arrhythm Electrophysiol Rev. 2020 Jun 3; 9(1): 8–14.,doi 10.15420/aer.2019.06, PMCID: PMC7330726,PMID: 32637114 The Role of the Electrophysiologist in Convergent Ablation, Nadeev Wijesuriya, Nikos Papageorgiou, Edd Maclean, Bunny Saberwal, and Syed Ahsancor.
Patient Symptoms
Patient Diagnosis
Patient History
Pulse Check
ECG
Echocardiogram & X-ray
Blood Test
AF Management and Risk
Most AF patients are initially prescribed medications to restore their heart rhythm, manage the symptoms of AF, or minimize their risk of stroke. Medications may cause unwanted side effects and 48% of patient's treatment by antiarrhythmic drugs are unsuccessful.11
Anticoagulation
Better Symptom Management, including regular review
Cardiovascular and Comorbidity Risk Management
Af Rate Control Medications- Anticoagulation & Rate and Rhythm Management
Calcium Channel Blockers
Interrupts the movement of calcium into the heart and blood vessel tissues to slow heart rate.
Beta Blockers
Slows heart rate, relaxes blood vessels and make it easier for the heart to pump blood.
AF Rhythm Control Heart Medications
Multiple rhythm control options exist, often influencing electrolyte balance within the heart to slow conduction and impact heart rhythm
Sodium Channel Blockers
Slows the electrical conductivity of your heart to improve arrythmia.
Antiarrhythmic Medication
Works to restore and/or maintain normal sinus rhythm.
Anticoagulant Medication
Reduces the risk of blood clots and stroke.
Three Main Types of AF
Paroxysmal AF
AF finishes spontaneously or by treatment within 7 days since the episode first began and may happen again.
Persistent AF
AF episode continues for more than 7 days and is unlikely to stop on its own.
Permanent AF
Patient and Healthcare Professional make a joint decision to stop attempts to restore or maintain the natural rhythm of the heart.