NHG-Richtlijnen
NHG-Standaard
M79
5.3
mei 2020
december 2024
K. Hart-vaatstelsel

Richtlijnen diagnostiek

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Spoed

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Anamnese

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Lichamelijk onderzoek

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Aanvullend onderzoek

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Evaluatie

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Richtlijnen beleid

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Eerste overwegingen na vaststellen nieuw atriumfibrilleren

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Voorlichting

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Niet-medicamenteuze behandeling

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Medicamenteuze behandeling

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Preventie van trombo-embolie met orale anticoagulantia

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Verlaging van de ventrikelvolgfrequentie

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Controles

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Consultatie en verwijzing

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Belangrijkste wijzigingen

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Kernboodschappen

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Inleiding

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Scope

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Buiten de scope

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Achtergronden

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Begrippen

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Atriumfibrilleren

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Orale anticoagulantia

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Epidemiologie

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Incidentie en prevalentie

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Comorbiditeit

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Pathofysiologie

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Pathofysiologie van atriumfibrilleren

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Risicofactoren voor atriumfibrilleren

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Voorspellers voor trombo-embolische complicaties

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Richtlijnen diagnostiek

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Spoed

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Redenen om atriumfibrilleren te vermoeden

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Screening

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Anamnese

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Lichamelijk onderzoek

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Aanvullend onderzoek

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Ecg

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Ambulante ritmeregistratie

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Laboratoriumonderzoek

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Echocardiografie

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Evaluatie

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Richtlijnen beleid

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Uitgangspunten

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Eerste overwegingen na vaststellen nieuw atriumfibrilleren

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Voorlichting

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Niet-medicamenteuze behandeling

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Leefstijladviezen

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Medicamenteuze behandeling

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Preventie van trombo-embolie met orale anticoagulantia

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Keuze van medicatie
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Indicaties orale anticoagulantia
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Contra-indicaties orale anticoagulantia
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Keuze tussen DOAC of VKA
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Antistolling bij kwetsbare ouderen

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Atriumfibrilleren tijdens intercurrente ziekte
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Aandachtspunten bij orale anticoagulantia
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DOAC’s
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VKA’s
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Omzetten van VKA naar DOAC en andersom
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Verlaging van de ventrikelvolgfrequentie

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Indicaties verlaging ventrikelfrequentie
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Keuze van medicatie bij patiënten zonder klinische tekenen van overvulling wijzend op hartfalen
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Keuze van medicatie bij patiënten met klinische tekenen van overvulling wijzend op hartfalen
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Voorkeursmiddelen bètablokkers
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Voorkeursmiddelen calciumantagonisten
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Toepassing van digoxine
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Antiaritmica bij paroxismaal atriumfibrilleren
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Controles

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Bij patiënten met nieuw vastgesteld atriumfibrilleren

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Werkwijze controles

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Organisatie van zorg

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Minderen en stoppen van medicatie bij kwetsbare ouderen

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Consultatie en verwijzing

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Direct overleg met de cardioloog

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Verwijzing bij nieuw vastgesteld atriumfibrilleren

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Overige indicaties voor verwijzing

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Behandelopties in de tweedelijn

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Cardioversie versus verlaging ventrikelvolgfrequentie
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Cardioversie
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Overige interventies in de tweede lijn
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Referenties

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NHG-werkgroep Atriumfibrilleren
Boelman L, Geersing GJ, Hemels MEW, Jongerius S, Joosten LPT, Olk H, Ruigrok S, Schep-Akkerman AE, Schoenmakers M, Van Doorn S, Verheij AAA, Wiersma Tj.
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