AFib and Flutter

Question 1

What is the MC sustained irregular rhythm?

Answer 1

A Fib

Question 2

What populations are more at risk for A Fib?

Answer 2

White males

65+ yo

Question 3

What disorder is often related to atrial stretching or scarring?

Answer 3

A Fib

Question 4

What can cause A Fib?

Answer 4

• Hyperthyroidism
• Acute vagotonic episodes
• Acute ETOH intoxication
• Post-op
• End stage lung disease

Question 5

What is the leading cause of stroke?

Answer 5

A Fib

Question 6

Describe what A Fib is

Answer 6

Disorganized, rapid atrial activation by any foci

Question 7

Where are A Fib ectopic foci MC located?

Answer 7

Ostial portion of pulmonary veins

Question 8

Majority of episodes of paroxysmal AF are triggered by?

Answer 8

Atrial premature beats

Question 9

How does AF look on EKG?

Answer 9

• Rapid irregularly irregular HR

- No discernible P waves

Question 10

What is the biggest consequence of AF?

Answer 10

Stasis of blood in the atria can lead to clotting and thromboembolic events

Question 11

Classifications of AF

Answer 11

• Paroxysmal: intermittent
• Persistent: fails to self terminate within 7 days
• Permanent: 12+ months
• Lone: no other associated heart defects or diseases

Question 12

What can be used to assess stroke risk in patients with AF?

Answer 12

CHADS2 score

Question 13

Treatment of AF?

Answer 13

• Try cardioversion for any new onset
• BB and CCB to control HR
• Anticoag for prevention of embolization

Question 14

What lab should be drawn for all patients with first episode of AF?

Answer 14

TSH

Question 15

What is the caveat surrounding cardioversion of AF?

Answer 15

• Anticoag (heparin) needs to be given beforehand

- If greater than 48 hrs of AF, full oral anticoag for 3 weeks needed before cardioversion

Question 16

Is atrial flutter more or less common than AF?

Answer 16

LESS but can lead to AF

Question 17

When does atrial flutter commonly occur?

Answer 17

After starting antiarrhythmic for AF

Question 18

Is rate control more or less difficult with atrial flutter compared to AF?

Answer 18

MORE difficult

Question 19

Treatment of atrial flutter?

Answer 19

• Try cardioversion
• BB or CCB to control HR
• Ablation of IVC and tricuspid annulus pathway (Type 1)

Question 20

What is more effective in treating atrial flutter - antiarrhythmics or cardioversion?

Answer 20

Cardioversion

Question 21

Rate control in atrial flutter commonly requires what else?

Answer 21

RF ablation

Question 22

What can RF ablation be used for?

Answer 22

To convert to and maintain NSR in atrial flutter