Cardiovascular Journal of Africa: Vol 29 No 3 (May/Junel 2018)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 3, May/June 2018

198

AFRICA

To reduce the risk of thromboembolism, appropriate oral

anticoagulation should be offered to patients with AF and AFL and

who do not have any contra-indications to vitamin K antagonists

(VKAs) or non-vitamin K oral anticoagulants (NOACs).

On the

other hand, patients with MAT do not require anticoagulation.

Uncontrolled tachyarrhythmia due to atrial fibrillation or

flutter can result in acute cardiac decompensation as well as

tachycardia-induced cardiomyopathy (TIC) in the long term.

Rate control is therefore an essential part in the treatment of AF

and AFL.

In atrial fibrillation, rhythm control was not found to be

superior to rate control in the AFFIRM and RACE trials.

14,15

Rhythm-control strategies were often associated with drug

toxicity of anti-arrhythmic drugs and failure to maintain sinus

rhythm in atrial fibrillation. Pulmonary vein isolation (PVI) is

another rhythm-control strategy that may not require additional

anti-arrhythmic drugs. Catheter ablation (pulmonary vein

isolation) can improve LV systolic function in patients with AF

and reduced LVEF and may improve survival.

In atrial flutter, a rhythm-control strategy is often preferred

over a rate-control strategy. Radiofrequency ablation is a highly

effective treatment of typical atrial flutter involving the right

atrial cavotricuspid isthmus. For these reasons, rate control

of atrial flutter is usually not a long-term option, especially if

patients are symptomatic, if the ventricular rate is difficult to

control (which is not uncommon) and if there is an associated

tachycardia-induced cardiomyopathy.

Previous studies have

found an improvement in LV systolic function after RFA in

patients with AFL and a reduced LVEF.

18,19

MAT is treated by treating the underlying lung disease.

Beta-

blockers are often not well tolerated in this population.

The images used for this ECG series are from ECG APPtitude and are used

with permission. The authors thank Professor Rob Scott Millar for the ECG

examples used in Figs 2–5, from the Rob Scott Millar ECG Library at the

Groote Schuur Cardiac Clinic.

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