Recommendations
for secondary prevention of AF with ‘upstream’ therapy |
|
Recommendations | Evidencia |
Pre-treatment with ACEIs and ARBs may be considered in
patients with recurrent AF and receiving antiarrhythmic drug therapy. |
IIb B |
ARBs or ACEIs may be useful for prevention of recurrent
paroxysmal AF or in patients with persistent AF undergoing electrical cardioversion in the absence of significant structural heart disease if these agents are indicated for other reasons (e.g. hypertension). |
IIb B |
ACEI: angiotensin-converting enzyme inhibitor; AF.: atrial
fibrillation; ARB: angiotensin receptor blocker. |
Recommendations
for primary prevention of AF with ‘upstream’ therapy |
|
Recommendations | Evidencia |
ACEIs and ARBs should be
considered for prevention of newonset AF in patients with heart failure and reduced ejection fraction. |
IIa B |
ACEIs and ARBs should be considered
for prevention of new-onset AF in patients with hypertension, particularly with left ventricular hypertrophy. |
IIb A |
Statins should be considered for
prevention of new-onset AF after coronary artery bypass grafting, isolated or in combination with valvular interventions |
IIa B |
Statins may be considered for prevention
of new-onset AF in patients with underlying heart disease, particularly heart failure. |
IIb B |
Upstream therapies with ACEIs,
ARBs, and statins are not recommended for primary prevention of AF in patients without cardiovascular disease. |
III C |
ACEI: angiotensin-converting enzyme inhibitor; AF:atrial
fibrillation; ARB: angiotensin receptor blocker. |
Normal | HTA | CAD | CFH | ||||||||||
No HVI | HVI | NYHA I-II | NYHA III-IV | ||||||||||
Dronedarona | |||||||||||||
Dofetilide | Dofetilide | Dofetilide | Dofetilide | ||||||||||
Flecainida | Dronedarona | Dronedarona | Dronedarona | ||||||||||
Propafenona | Sotalol | ||||||||||||
Sotalol | |||||||||||||
A m i o d ar o n a | |||||||||||||
RC: estrategia Ritmo Control |
Droga | Dosis vo | Contraindicaciones |
Flecainida | 50-200 mg/12 h | clcr >50 mg/ml |
Flecainida XL | 200 mg/dia | |
Propafenona | 150-300 mg/8h | contraindicado en CAD |
Propafenona SR | 225-425 mg/12 | precaución en AKI |
Sotalol | 40-160 mg/12 | HVI, FVI, hipoK, clcr< 50 |
Amiodarona | 600 mg/día 4 sem | ojo QT largo |
400 mg/día 4 sem | aumenta VKA | |
200 mg/día | ||
Dronedarone | 400 mg/12h | NYHA II-IV |
Disopiramida | 100-250 mg x3 | FVI anterogrado |
Droga | Dosis | dosis seguimiento |
Amiodarona iv | 5-7 mg/kg en 1-2 h | 50 mg/h (max 1 g. en 24 horas) |
Amiodarona vo | 200 mg/6-8 h,hasta 1 g. | 200 mg/día |
Flecainida | 1.5-2 mg/kg/iv en 10 min | NO |
200-300 mg/vo* | ||
Propafenona | 1.5-2 mg/kg. iv en 10 min | |
450-600 mg.vo* | ||
Ibutilide | 1 mg/iv. en 10 min. | Repetir una 2º dosis si precisa |
Vernakalant | 3 mg/kg iv. en 10 min. | 2 mg/kg. en 10 min. |
Ritmo control FA de reciente comienzo ≤ 48 h > 48 h. o desconocido (si estrategia ritmo control) |
||||||||
Estabilidad
hemodinámica |
||||||||
NO | SI | |||||||
Cardioversión farmacológica |
||||||||
Enfermedad estructural
cardiaca |
||||||||
NO | SI | |||||||
DCC |
Flecainida IV (IA) Propafenona IV (IA) Flecainida oral (IIa B) Propafenona vo.(IIaB) Ibutilide iv (IIbA) |
Amiodarona iv (IA) Amiodarona vo. (IIaA) |
β-Bloqueantes o diltiazem o verapamil
↓
añadir digoxina
β-Bloqueantes a dosis mínimas
Amiodarona en pacientes con FEVI severamente diprimida
↓
Añadir Digoxina si precisa
Inactividad | HTA | Insuf. Cardiaca | EPOC |
HFpEF | |||
Digital | β-Bloq. | β-Bloq. Digital | Diltiazem |
Diltiazem | Verapamil | ||
Verapamil | Digital | ||
Digital | β1-Bloq.* | ||
Amiodarona si no hay respuesta a lo anterior |
Droga | IV adm | oral mantenimiento |
β-Bloqueantes (I-B) | ||
Esmolol | 0.5 mg/kg Bolus 1-2 min | N/A |
Metoprolol | 2.5-5 mg | 100-200 mg/dia |
Bisoprolol | N/A | 2.5-10 mg/dia |
Atenolol | N/A | 25-100 mg/dia |
Propanolol | 1 mg | 10-20 mg x 3 |
Carvedilol | N/A | 3.125-25 x 2 |
*Calcioantagonistas (I-B) | ||
Verapamil | 2.5-10 mg | 40-120 mg x 3/dia - 360 mg retard |
Diltiazem | 15-25 mg. | 60 mg x 3/dia - 360 mg retard |
Digital | ||
Digoxina | 0.5 mg 0.75-1.5 mg/d | 0.125 -0.5 /dia |
Digitoxina | 0.4-0.6 mg | 0.05 mg-0.1 mg/dia |
Amiodarona (en UCI/ IIa) | ||
Amiodarona | 5 mg/kg 1 h | 100-200 mg/ dia |
50 mg/h | ||
Dronedarone contraindicada para frecuencia control (IIIB) |