Atrial Fibrillation – a Workable Concept for Diagnosis and Management in Family Medicine
DOI: 10.3238/zfa.2011.0310german translation / full article
Summary: Atrial fibrillation is one of the most common heart rhythm disturbances seen in family medicine, which is primarily due to an ageing population. Commonly, hemodynamically stable patients can be cared for in close cooperation between family practitioner and cardiologist. Basically, there are two important clinical aspects of atrial fibrillation: 1. the arrhythmia itself leading to bradycardia and/or tachycardia. 2. the increased risk of stroke. Heart rhythm disturbances can be treated either by stabilising the sinus rhythm or the heart rate. The decision for one of these two options is based on kind and duration of atrial fibrillation (paroxysmal, persistent, permanent or acute vs chronic) and severity of symptoms. Restoration and maintainance of sinus rhythm can be achieved by different medical and interventional procedures (antiarrhythmic drugs, direct current cardioversion, pulmonary vein isolation). Heart rate control can be achieved by drug treatment, sometimes combined with pace maker implantation and AV-node ablation. The individual risk of stroke can be calculated using the CHADS2-Score or the CHA2DS2VASc-Score. Patients receive anticoagulatory treatment according to their calculated risk. (aspirin, clopidogrel, coumarin derivative). The risk of stroke is independent of kind and duration of atrial fibrillation (paroxysmal, persistent, permanent or acute vs chronic). New anticoagulatory substances without the need of continous monitoring are expected to be licensed for this indication by the end of this year. Routine use of these new substances in non-privately insured patients will depend on pricing by the pharmaceutical industry.