AFib + AFlutter

Question 1

List complications of AFib

Answer 1

• Stroke, Thromboembolism, HF

* TachyC-induced Cardiomyopathy and Critical Cardiac Ischaemia due to persistently elevated ventricular rate in AF

Question 2

Compare the 3 types of AF

Answer 2

• Paroxysmal: Sudden episodes, stop suddenly within 2-7 days without treatment
• Persistent: Lasts >7 days, likely to need treatment
• Permanent: Long-term, HR doesn’t return to normal rhythm but treatment reduces rate

Question 3

Describe and list AFib symptoms

Answer 3

• Most are asymptomatic, caught by chance when pulse felt (may be fast or irregular- speed/force)
• Symptoms usually start suddenly: Palpitations, Dizziness/ Syncope, Chest pains/ Angina, SoB (often 1st to present)

Question 4

List alternate diagnoses to AFib

Answer 4

AFlutter

Atrial extrasystoles, Ventricuar ectopic beat

Sinus TachyC, SVTs

Sinus rythm with premature Atrial/ Ventricular contractions

Question 5

How does AFlutter look on an ECG

Answer 5

Saw-tooth pattern of regular atrial activation on ECG

Question 6

List investigations for AFib

Answer 6

FBC, Echocardiogram, ECG during AF episode

Question 7

What things must be assessed in a pt presenting with AFib

Answer 7

Haemodynamically stable or not?

• Unstable: Admit for urgent cardioversion
• Stable: Admit or manage in primary
• Stroke risk (CHADS-Vasc tool)
• Risks/ Benefits of Anticoagulation (ORBIT tool)

Question 8

AFib treatment involves Rate and Rhythm control

Outline rate control, including what to do if symptoms not controlled

Answer 8

• B-Blocker/ Digoxin/ Rate-limiting CCB
• If symptoms not controlled, consider increasing dose or combination therapy
• If still not controlled, refer within 4wks

Question 9

How high can the HR be in AFib? What is it usually?

What is the goal of Rate control treatment?

Answer 9

Can be upto 180, commonly 120-60

Goal: HR<90 when resting. Pulse may still be irregular

Question 10

Outline Rhythm control in AFib treatment

Answer 10

• Referral for Cardioversion- Reverting erratic rhythm back to normal
• Electric shock, Medication (Amiodarone) or Catheter Ablation

Question 11

Outline AFlutter treatment

Similar to AFib, but AFlutter responds less well to drug treatment

Answer 11

Rate control;

• B-blocker or rate-controlling CCB (Diltiazem, Verapmil)
• Digoxin if not not helping or in HF

Rhythm: Electrical/ Drug/ Catheter ablation

Question 12

When can’t you do cardioversion to treat AFlutter?

Answer 12

Don’t attempt Cardioversion if duration >48hrs or unknown, unless pt fully anticoagulated for at least 3wks

Question 13

Outline the follow-up of Rate control treatment

Answer 13

Within 1wk of starting/ altering dose

Question 14

Outline the follow-up/ monitoring of Anticoagulant treatment

Answer 14

If on Warfarin;
- Monitor INR daily/ alternate days until between 2 and 3 on 2 consecutive occasions, then x2/week for 1-2wks, then x1/week, then at longer intervals (e.g once every 12wks)

Calculate Time in Therapeutic Range (TTR) at each visit;

   - Calculate over maintenance period of at least 6mths
    - Exclude measurements during 1st 6wks of treatment