Arrhythmias Flashcards
What are the main types of arrhythmias? (5)
- AFib
- Atrial flutter
- Paroxysmal SVT
- Arrhythmias after MI (paroxysmal tachycardia, rapid irregularity, bradycardia)
- VTach (pulseless v-tach or VF)
What treatment is required for ectopic beats?
If spontaneous and the patient has a normal heart, treatment is rarely required and reassurance will suffice
If they are particularly troublesome, beta-blockers are sometimes effective and may be safer than other suppressant drugs
What are the treatment goals in the management of AFib? (3)
Rate control
Rhythm control
Stroke prevention
What is the management of life-threatening hemodynamically unstable new-onset AFib?
Emergency electrical cardioversion WITHOUT delaying to achieve anticoagulation
What is the management of non-life-threatening hemodynamically STABLE new-onset AFib (<48 hours)?
Rate OR rhythm control
What treatment is preferred for management of non-life-threatening hemodynamically STABLE new onset AFib presenting after 48 hours or if duration is uncertain?
Rate control (and anticoagulation)
What is the cutoff for cardioversion in patients with acute AFib?
48 hours
- if less than 48 hours, rate or rhythm control
- if more than 48 hours, rate control only (no cardioversion before anticoagulation)
What are the options for chemical cardioversion in the treatment of AFib? (2)
- Amiodarone (preferred if there is structural heart disease)
- Flecainide
What are the options for urgent rate control in AFib? (2)
- IV beta-blocker
2. IV verapamil
When is electrical cardioversion preferred to chemical?
If AFib has been present for more than 48 hours, electrical cardioversion is preferred and should not be attempted until the patient is fully anticoagulated for AT LEAST 3 weeks
- if this is not possible, parenteral anticoagulation should be commenced, and a left atrial thrombus ruled out immediately before cardioversion
** prior to cardioversion, offer rate control as appropriate
What may be offered to patients with AFib in the interim before cardioversion is performed?
Rate control
Is it necessary to continue oral anticoagulation after cardioversion?
Yes, for at least 4 weeks
For patients receiving cardioversion for AFib with onset >48 hrs, how long should they be anticoagulated first?
At least 3 weeks
Rate control the preferred first-line drug treatment strategy for AFib EXCEPT in patients with… (4)
- New-onset AFib
- Atrial flutter suitable for an ablation strategy
- AFib with a reversible cause
- If rhythm control is more suitable based on clinical judgement
What are the main options for controlling ventricular rate? (2)
- Beta-blocker (not sotalol)
- Non-dihydropyridine CCB (diltiazem or verapamil)
- Digoxin is usually only effective for controlling the ventricular rate at rest, and should therefore only be used as monotherapy in predominantly sedentary patients with non-paroxysmal atrial fibrillation.
When a single drug fails to adequately control the ventricular rate, what drug combinations can be offered?
A combination of two drugs including a beta-blocker, digoxin, or diltiazem
If ventricular function is diminished, what drug combination is preferred for controlling ventricular rate?
Beta-blocker + digoxin
What drug is preferred for managing AFib in patients with heart failure?
Digoxin
What drug may be used to maintain sinus rhythm in patients with AFib post-cardioversion?
A beta-blocker
- If a standard beta-blocker is not appropriate or is ineffective, consider an oral anti-arrhythmic drug such as sotalol hydrochloride, flecainide acetate, propafenone hydrochloride, or amiodarone hydrochloride
What drug may be used before and after electrical cardioversion for AFib to increase success of the procedure and maintain sinus rhythm?
Amiodarone 4 weeks before and continuing for up to 12 months after
What ‘rhythm control’ drugs should be avoided in patients with known ischemic or structural heart disease? (2)
- Flecainide
- Propane one
- Consider amiodarone hydrochloride in patients with left ventricular impairment or heart failure.
Which ‘rhythm control’ drug is preferred in patients with LV impairment or HF?
Amiodarone
How is paroxysmal AFib defined?
Episodes of AFib that self-terminate within 7 days, usually within 48 hours, without any treatment
What is the ‘Pill-in-pocket’ strategy for PAFib?
The person self-manages paroxysmal AFib by taking anti arrhythmic drugs only when an episode of atrial fibrillation starts