What to do when atrial fibrillation occurs? Scientific treatment of acute atrial fibrillation

It is very important to deal with atrial fibrillation attacks, especially the care of acute atrial fibrillation attacks. It should be treated according to the patient's physical signs, symptoms and duration. If it cannot be treated, medical treatment must be sought in time to minimize the harm to the patient.

1. Patients with acute atrial fibrillation and hemodynamic instability , or patients with atrial fibrillation and preexcitation syndrome with a ventricular rate of 250 beats/min, should be given synchronized direct current cardioversion immediately. Heparin or new oral anticoagulants should be given before cardioversion; if emergency electrical cardioversion is required and there is no time for anticoagulation in advance, anticoagulation treatment should be given immediately after cardioversion. If the duration of atrial fibrillation is ≥48 hours, or the duration is uncertain, anticoagulation therapy should be continued for 4 weeks after cardioversion, and then the decision on whether to perform long-term anticoagulation therapy should be made based on the CHA2DS2-VASc risk score.

2. For patients with hemodynamically stable acute atrial fibrillation , the principle of treatment is to assess the risks associated with atrial fibrillation and relieve the patient's discomfort. Clinical evaluation includes the onset time and duration of atrial fibrillation, symptom score of atrial fibrillation, risk of thromboembolism, factors inducing atrial fibrillation and the presence of complications; electrocardiogram to understand whether there is acute or old myocardial infarction, bundle branch block, ventricular preexcitation, etc., to evaluate whether there is heart failure and cardiomyopathy, and head CT to evaluate whether there is stroke when necessary. After the assessment is completed, the specific processing principles are as follows:

3. For patients with paroxysmal atrial fibrillation lasting less than 48 hours, if the usual atrial fibrillation lasts less than 24 hours or it is the first onset of atrial fibrillation, cardioversion may not be temporarily performed, and only the ventricular rate should be controlled and observation should be paid attention to, because most atrial fibrillation attacks may convert to sinus rhythm on their own within 24 hours. If the usual attack lasts longer (≥48 hours), anticoagulation should be started as soon as possible, and sinus rhythm conversion treatment should be considered. For patients with paroxysmal atrial fibrillation lasting ≥48 hours or with uncertain duration, cardioversion can be performed after 3 weeks of effective anticoagulation treatment, or after excluding atrial thrombus through esophageal ultrasound examination during anticoagulation treatment. The principles of anticoagulation treatment after cardioversion are the same as before. For patients with persistent atrial fibrillation during the exacerbation period, the main considerations are anticoagulation therapy and ventricular rate control. Then, whether to convert to sinus rhythm is decided based on the duration of atrial fibrillation, atrial size, and patient wishes.

The above is the general process of dealing with acute atrial fibrillation attacks, but the clinical conditions often vary greatly. As a patient, you should be aware of the severity of the disease, learn to self-assess, and seek medical attention immediately when necessary.