A Fib Management

Question 1

What is the preferred 1st line strategy for A Fib

Answer 1

Rate control

Question 2

Exceptions to rate control strategy

Answer 2

Reversible
AF induced HF
<48 hrs onset
with Atrial Flutter

Question 3

What is used for rate control

Answer 3

BB’s
2nd Line: CCB’s
3rd Line: Digoxin (esp in coexisting HF)

Question 4

What is used for rhythm control

Answer 4

BB’s

2nd line AFTER cardioversion: Dronedarone

w/ Coexisting HF: Amiodarone

Question 5

No response or do not want anti arrythmic and are stable?

Answer 5

Catheter ablation

Anticoagulate 4 weeks before and after

Question 6

What are the 2 circumstances where cardioversion is performed?

Answer 6

Electrical is patient is unstable

Electrical or pharmacological if rhythm control is preferred

Question 7

AF < 48 hours cardioversion

Answer 7

Heparinised

Electrical - DC cardioversion

Pharmacological - amiodarone if structural disease

Flecainide or amiodarone is no disease

No need to antiocoagulate after if AF confirmed <48 hours and ChadVasc Low

Question 8

> 48 hours cardioversion + STABLE

Answer 8

3 weeks of anticoag then electrical cardioversion

If high risk of failure or if this is a recurrent AF, them amiodarone or sotalol 4 weeks before

Anticoagulate for at least 4 weeks after