EMTs and paramedics interested in brushing up on AFib treatment protocols can take a glance at a few highlights from the American Heart Association’s new protocols.

And if a cardiology specialty is a career interest down the road for you, especially working with AFib treatment, it’s a must-read.

Atrial fibrillation, or AFib, is a heart condition associated with an irregular heartbeat and might pose other risks such as stroke, blood clots, and heart failure, according to the AHA.

The 2019 Guideline for the Management of Patients with Atrial Fibrillation was developed by the American College of Cardiology and AHA Task Force. The Journal of the American College of Cardiology and Heart Rhythm Society co-published the guidelines, which serve as an update to the 2014 guidelines. (There is a 14-page short version and a 49-page long version.)

The short version outlines new treatment protocols, new thinking and changes in definitions.

Here are a few highlights from lead author Craig T. January, MD, PhD, FACC, who offers some key updates to hone in on when treating patients with AFib.
atrial fibrillation

10 atrial fibrillation symptoms that patients often present with, according to the American Heart Association:

  1. General fatigue
  2. Rapid and irregular heartbeat
  3. Fluttering or “thumping” in the chest
  4. Dizziness
  5. Shortness of breath and anxiety
  6. Weakness
  7. Faintness or confusion
  8. Fatigue when exercising
  9. Sweating
  10. Chest pain or pressure

Defining atrial fibrillation terms

As an EMT or paramedic, administering AFib treatment may not be an everyday occurrence, January said. Even so, it is useful to stay abreast of the current teachings and changes.

Looking back at previous versions of the guidelines, January said the authors realized they needed to give a better, more clearly defined explanation of the types of AFib.

Two terms healthcare professionals are familiar with are valvular and non-valvular AFib. However, the 2019 guidelines nixed the term non-valvular AFib because the term was confusing, he said.

Valvular AFib generally refers to patients with mitral valve disease or an artificial valve.

A more detailed definition can be found on page 10 of the full guideline report, plus a redefined version of the term non-valvular AFib.

The Heart Rhythm Society defines the three types of AFib:

  • Paroxysmal atrial fibrillation – AFib that occurs sometimes and then stops. AFib stops by itself and the heart returns to normal rhythm.

  • Persistent atrial fibrillation – AFib that does not stop by itself.

  • Long-standing persistent atrial fibrillation (formerly known as permanent atrial fibrillation) – AFib that cannot be corrected.

January said the treatment option is the same regardless which type of atrial fibrillation a patient experiences.

“Patients with AFib are at risk for thromboembolism, or stroke and should be anticoagulated,” January said. “The type of AFib — permanent, persistent or paroxysmal — should not influence the decision to consider anticoagulation.”

A cheat sheet on pages 4 and 5 of the AFib guidelines offers a quick reference comparison tool from 2014 to 2019 and is a highly recommended short read.

Stroke risks to consider when administering AFib treatment

AFib treatment depends on many factors, and it’s primarily cardiologists and neurologists who treat the disease, January said.

“In the 2014 guidelines, we considered (Novel Oral Anticoagulants) equivalent to Warfarin. Now we prefer NOACs — of which four types exist. There’s less [of a] bleeding risk with NOACs compared to Warfarin,” he said.

Still, first responders and paramedics need to be aware of the potential risks when a patient presents with AFib symptoms.

January points out the main risk of AFib is the association with blood clots. When blood clots travel to the brain, he said, that’s when a patient is at risk of stroke.

“Anticoagulation is the treatment to reduce stroke,” he said. “AFib can be permanent, persistent or paroxysmal, meaning it comes and goes. All three types pose risks. EMTs usually treat people with AFib, but most are not stroke patients.”

However, when EMTs arrive on the scene and suspect a patient is presenting with stroke symptoms, it’s always best when you have the right training under your belt.  The latest EMS/pre-hospital stroke treatment materials from the American Stroke Association might come in handy.

We have just the thing to help you learn the necessary skills, designed to give you an edge when you make lifesaving decisions.

Take our Individual CCTR-L17– Includes Evidence Based Guidelines & Cardiovascular course to earn continuing medical education credits.