Abstract
Atrial fibrillation—no primary care physician can escape it! Atrial fibrillation is
the most common tachyarrhythmia encountered in clinical practice—whether family practice,
internal medicine, cardiology, pulmonology medicine, etc. Moreover, with growth of
the older segment of our population and better survival of patients with cardiovascular
disorders, the incidence and prevalence of atrial fibrillation are both increasing
progressively. Currently, a review of major guidelines shows that the treatment approach
to atrial fibrillation involves 4 “pillars”—treatment of contributory comorbidities
(“upstream therapy”), control of the ventricular response to the rapid atrial rates
during atrial fibrillation, prevention of thromboembolism with oral anticoagulation
or left atrial appendage occlusion (except in the minority of patients at too low
a thromboembolic risk), and rhythm control in those patients who require it. The latter
is the most complex of the 4, and many, if not most, primary care physicians currently
prefer to leave this “pillar” to the care of a cardiologist or electrophysiologist.
Nonetheless, it is important for the primary care physician to be familiar with the
rhythm treatment components and choices (both overall and, specifically, the ones
in which they must participate) as they will impact many interactions with their patients
in multiple ways. This review details for the primary care physician the components
of care regarding rhythm control of atrial fibrillation and the areas in which the
primary care physician/internist must be knowledgeable and proactively involved.
Keywords
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Article Info
Publication History
Published online: March 31, 2022
Footnotes
Funding: None.
Conflicts of Interest: Investigator: Johnson & Johnson, Sanofi; Consultant: Medtronic, Sanofi, Ascension, and Amarin; and has served on a speaker's bureau for Sanofi.
Authorship: The author is solely responsible for writing this article.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
