otherwise stable, BP=124/80mmHg. What is the most appropriate management?
a. Bisoprolol
b. ACEi
c. Ramipril
d. Digoxin
answer: A
Nice
1.6 Rate and rhythm control
When to offer rate or rhythm control
1.6.1 Offer rate control as the first‑line strategy to people with atrial fibrillation, except in people:
-
whose atrial fibrillation has a reversible cause
-
who have heart failure thought to be primarily caused by atrial fibrillation
-
with new‑onset atrial fibrillation
-
with atrial flutter whose condition is considered suitable for an ablation strategy to restore sinus rhythm
-
for whom a rhythm control strategy would be more suitable based on clinical judgement. [new 2014]
Rate control
1.6.2 Offer either a
standard beta‑blocker (that is, a beta‑blocker other than sotalol) or a
rate‑limiting calcium‑channel blocker as initial monotherapy to people
with atrial fibrillation who need drug treatment as part of a rate
control strategy. Base the choice of drug on the person's symptoms,
heart rate, comorbidities and preferences when considering drug
treatment. [new 2014]
1.6.3 Consider
digoxin monotherapy for people with non‑paroxysmal atrial fibrillation
only if they are sedentary (do no or very little physical exercise). [new 2014]
1.6.4 If monotherapy
does not control symptoms, and if continuing symptoms are thought to be
due to poor ventricular rate control, consider combination therapy with
any 2 of the following:
-
a beta‑blocker
-
diltiazem
-
digoxin. [new 2014]
1.6.5 Do not offer amiodarone for long‑term rate control. [new 2014]
Rhythm control
1.6.6 Consider
pharmacological and/or electrical rhythm control for people with atrial
fibrillation whose symptoms continue after heart rate has been
controlled or for whom a rate‑control strategy has not been successful. [new 2014]
Cardioversion
1.6.7 For people
having cardioversion for atrial fibrillation that has persisted for
longer than 48 hours, offer electrical (rather than pharmacological)
cardioversion. [new 2014]
1.6.8 Consider
amiodarone therapy starting 4 weeks before and continuing for up to
12 months after electrical cardioversion to maintain sinus rhythm, and
discuss the benefits and risks of amiodarone with the person. [new 2014]
1.6.9 For people with atrial fibrillation of greater than 48 hours' duration, in whom elective cardioversion is indicated:
-
both transoesophageal echocardiography
(TOE)‑guided cardioversion and conventional cardioversion should be
considered equally effective
-
a TOE‑guided cardioversion strategy should be considered:
-
where experienced staff and appropriate facilities are available and
-
where a minimal period of precardioversion anticoagulation is indicated due to the person's choice or bleeding risks. [2006]
-
where experienced staff and appropriate facilities are available and
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