Diagnóstico y tratamiento de la fibrilación auricular. Revisión Sistemática

Abstract

Introduction: Atrial fibrillation (AF) is a tachyarrhythmia in which the atria beat uncoordinatedly at elevated rates, making timely diagnosis and effective treatment essential. Objective: To identify the most effective diagnostic methods and treatments for atrial fibrillation through a systematic review. Methodology: A qualitative and descriptive study was conducted by reviewing articles from scientific databases, following the PRISMA guidelines. Results: The electrocardiogram is the most effective diagnostic method, with a sensitivity of 94–98% and a specificity of 76–95%. Regarding treatment, anticoagulants play a crucial role in managing hemorrhagic risk. Vitamin K antagonists (VKAs) are recommended for patients with structural heart disease, while direct oral anticoagulants (DOACs) are preferred for those without such conditions. Factors including symptomatology, hemodynamics, and recurrence are considered for cardioversion. Pharmacological cardioversion is effective for episodes lasting <48 hours in patients with stable hemodynamics, while electrical cardioversion is recommended for the opposite scenario. Ablation provides more significant benefits in patients with AF and heart failure. Comorbidities are associated with increased morbidity and mortality. Conclusions: The electrocardiogram is the most valuable diagnostic tool, but cardiac Holter monitoring offers more significant benefits for paroxysmal episodes. VKAs are superior to DOACs; however, for non-valvular AF, DOACs have proven equally effective. Flecainide and propafenone show the highest success rates in restoring rhythm, while beta-blockers outperform calcium channel blockers and glycosides in maintaining heart rate. Regarding comorbidities, they increase the risk of AF episodes.