Atrial Fibrillation – Medical Disorders
Medical Disorders
Atrial Fibrillation
What type of atrial fibrillation (AF or Afib) do you have?
The duration of AF is used to classify this disorder into different types:
- Paroxysmal fibrillation – the heart returns to regular rhythm on its own;
- Persistent AF – irregular heart beats lasting longer than 48 hours and will require medications to return to normal sinus rhythm;
- Permanent or chronic AF – irregular heart beats that will not return to normal rhythm even with medications.
What other conditions are associated with your AF?
AF is a type of arrhythmia that is associated with comorbidities (see below) with a high degree of morbidity and mortality.
Severity and stability of these comorbid conditions determine dental management of a patient.
It is estimated that persons with persistent AF have a 5x increased risk to develop a stroke.
Comorbid diseases and conditions
| Cardiac disease | Noncardiac disease |
|---|---|
| Reumatic fever, heart failure, valvular heart disease, ventricular function impairment, cardiomyopathy, mitral valve prolapse, thromboembolic events, including angina, myocardial infarction and stroke, decreased cardiac output, hypertension, hypotension, pulmonary congestion | Acute infection, pulmonary conditions including lung carcinoma, hyperthyroidism, excessive alcohol intake, diabetes |
What signs and symptoms of AF do you experience?
Signs and symptoms are usually associated with cardiac comorbidities and include dizziness, faintness and confusion, sweating, exercise intolerance, weakness, fatigue, heart palpitations, chest pain, and shortness of breath.
Silent cerebral ischemic events may present as cognitive deficits.
How is your condition being medically managed?
For patients with AF and an estimated annual thromboembolic risk of ≥2% per year (eg, CHA2DS2-VASc score of ≥2 in men and ≥3 in women), anticoagulation therapy is recommended to prevent stroke and systemic thromboembolism.
In patients with AF who do not have a history of moderate to severe rheumatic mitral stenosis or a mechanical heart valve, and who are candidates for anticoagulation, DOACs are recommended over warfarin (except for mitral stenosis and mechanical heart valves) to reduce the risk of mortality, stroke, systemic embolism, and intracranial hemorrhage (ICH).
The mainstay of AF therapy is based on prevention of thromboembolic events with anticoagulation therapy and stabilization of the arrhythmia with medications, pacemakers, and defibrillators.
Medications indicate type, severity, and stability of underlying condition(s).
When was the last time you were hospitalized to treat your AF?
There is an increased mortality rate within 30 days after hospitalization for AF among individuals with AF undergoing even minor surgical procedures.
⚠Do not provide elective dental care within 30 days after hospitalization for AF.
Related Pages
- Oral Health Care Considerations
- Classifications and definitions
References/Websites
- References
- Atrial Fibrillation. Ann Intern Med. 2017;166(5):ITC33-ITC48.
- Gažová A, et al. Predictive value of CHA2DS2-VASc scores regarding the risk of stroke and all-cause mortality in patients with atrial fibrillation (CONSORT compliant). Medicine (Baltimore). 2019; 98(31): e16560.
- Joglar JA, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024; 149(1): e1–e156.
- Websites