1. Etiological treatment: We should try our best to find the primary disease and inducing factors and carry out etiological treatment.
2. Acute attack: If the patient has a rapid ventricular rate and symptoms and signs of acute cardiovascular insufficiency, synchronous cardioversion should be the first choice. For patients with good cardiovascular function, the initial treatment goal is to slow down the ventricular rate. Use digitalis, beta blockers or verapamil to keep the ventricular rate at rest at 60-80 beats per minute, and the heart rate will not increase more than 0/00 beats per minute/kloc after light exercise. Digitalis can be used alone or in combination with beta blockers or calcium antagonists as needed. Beta blockers and verapamil should not be used in patients with heart failure and hypotension, and digitalis and verapamil should not be used in patients with preexcitation syndrome complicated with atrial fibrillation.
3. Paroxysmal atrial fibrillation: Paroxysmal atrial fibrillation is called when the duration of atrial fibrillation is shorter than 12 months, and the probability of successful cardioversion is greater, and the probability of maintaining sinus rhythm after cardioversion is greater. Quinidine is the most commonly used and effective class IA drug, but it may lead to fatal ventricular arrhythmia. Procaine amine is also very effective. Before cardioversion with class IA drugs, beta blockers should be given to slow down the conduction of atrioventricular node to prevent the drugs from antagonizing vagus nerve. Otherwise, when atrial fibrillation turns into atrial flutter, the hidden conduction of atrioventricular node will be weakened, leading to an increase in ventricular rate. The efficacy of class Ⅰ C drugs, such as flucaine and propafenone, in converting atrial fibrillation is similar to that of class Ⅰ A, but it can also lead to ventricular arrhythmia. Amiodarone can also effectively convert atrial fibrillation. When drug cardioversion is ineffective, try synchronous electrical cardioversion. In order to prevent left ventricular thrombosis, warfarin should be given for 3 weeks before cardioversion (to prolong the thromboplastin time to 1.3 ~ 1.5 times of the control value) and continue for 2 ~ 4 weeks after cardioversion.
Before deciding on cardioversion therapy for patients with chronic atrial fibrillation, we should fully consider whether atrial fibrillation can last for a long time after it turns into sinus rhythm. The duration of atrial fibrillation (the longer the course of the disease, the more difficult it is to maintain after cardioversion), the degree of atrial dilation (the larger the atrium, the lower the success rate) and the patient's age (the lower the success rate of elderly patients) are all important factors affecting the maintenance of sinus rhythm after cardioversion.
To prevent the recurrence of atrial fibrillation, quinidine, propafenone or amiodarone can be used.
At present, it has been reported that radiofrequency ablation has successfully treated paroxysmal atrial fibrillation.
4. Persistent atrial fibrillation: those whose atrial fibrillation lasts more than 12 months are called persistent atrial fibrillation. Generally, cardioversion is no longer used, but medication is used.
For rapid atrial fibrillation, digoxin is a commonly used oral drug. Excessive digoxin is toxic to the heart. Patients and their families must learn to listen to the ventricular rate with a stethoscope (be careful not to count the pulse) and adjust the dose according to the heart rate. If the heart rate is fast, the dosage will be increased, and if the heart rate is slow, the dosage will be reduced to keep the heart rate at 70-90 beats/min. Digoxin should be used for a long time. Digoxin poisoning patients can continue to use it as long as their condition requires after the poisoning is completely recovered.
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