Atrial Fibrillation

Question 1

AF is generally associated with an…

Answer 1

irregularly irregular ventricular rhythm & absence of distinct P waves.

Question 2

Paroxysmal AF

(i.e, self-terminating or intermittent)

Answer 2

AF that terminates spontaneously or with intervention within 7 days of onset.
- episodes may recur with variable frequency.

Question 3

Persistent AF

Answer 3

• AF that fails to self-terminate with 7days.
• episodes often require pharmacologic or electrical cardioversion to restore sinus rhythm.
• a pt who has had persistent AF can have later episodes of paroxysmal AF.

Question 4

Long-standing persistent AF

Answer 4

AF that has lasted for >12 months.

Question 5

Permanent AF

Answer 5

identifies persistent AF for which a joint decision by the pt + clinicial has been made to no longer pursue a rhythm control strategy.

Question 6

Classification of AF described by the 2014 AHAACC according to its
- duration
- length of episodes

Answer 6

1. Paroxysmal AF
2. Persistent AF
3. Long-standing persistent AF
4. Permanent AF

Question 7

Valvular AF

Answer 7

• refers to pts with moderate to severe mitral stenosis (MS)
• pts have a higher risk of stroke than pts without this condition.

Question 8

Lone AF

Answer 8

• describes AF in younger pts (≤60 years) with paroxysmal, persistent, or permanent AF who have no structural heart dxs or cardiovascular risk factors.
• these characteristics identify a group of individuals with a CHA2DS2-VASc score of “0” & who are at lowest risk for thromboembolism from AF.

Question 9

Rhythm control

Answer 9

• typically employs 1 or more of the following therapies to maintain sinus rhythm:

1. Antiarrhythmic drug therapy
2. Electrical cardioversion
3. Radiofrequency catheter ablation of the left atrium
4. Surgical ablation procedure performed at the time of open-heart surgery.

Question 10

Rate control

Answer 10

strategy that uses 1 or more of the following to keep the ventricular rate within a goal range:
1. Medications that block (slow conduction through) the AV = beta blockers, digoxin, rate-slowing nondihydropyridine calcium channel blockers.

2. AV nodal ablation + ventricular pacing to control symptoms = considered when pharmacologic therapy is ineffective.

Question 11

Unstable pts with AF

Answer 11

include those with:
- hypotension
- altered mental status
- ischemia
- heart failure
- cardiogenic shock
- very rapid ventricular rates

Question 12

In most pts who require urgent management, first employ a ____________. Exceptions are…

Answer 12

rate-control strategy

• exceptions are if the pt is hemodynamically unstable & successful ventricular rate control can’t be achieved.