Atrial fibrillation

Question 1

What determines treatment?

Answer 1

• Treatment is guided by the person’s symptoms, heart rate, co-morbidities and preferences.

Question 2

Step 1

Answer 2

• Amiodarone for 12 months

Question 3

step 2

Answer 3

• Stroke prevention in AF.
• Perform Stroke Assessment via CHA2DS2VASc.
• Score > 2 then anticoagulant is recommended.
• Warfarin or NOAC e.g Apixaban, Dabigatran or Rivaroxaban.

Question 4

step 3

Answer 4

• Offer Heparin at initial presentation till INR is within Range (2-3)

Question 5

Aims of treatment for AF

Answer 5

Treatment of AF aims to reduce stroke symptoms and prevent complications.

Question 6

Rate control in AF

Answer 6

• Beta-blocker
  OR
• Rate-limiting calcium channel blocker as monotherapy if BB not tolerated (e.g. Verapamil)

Question 7

Rhythm control

Answer 7

• Dronedarone is recommended as an option for people whose AF is not controlled by Beta Blockers and have hypertension and is 70 years of age and older.

Question 8

What is the CHA2DS2–VASc ?

Answer 8

C = Congestive heart failure

H = Hypertension: blood pressure consistently above 140/90 mmHg (or treated hypertension on medication)

A = Age ≥75 years

D = Diabetes mellitus

S2 = Prior Stroke or TIA or Thromboembolism

V = Vascular disease (e.g. peripheral artery disease, myocardial infarction, aortic plaque)

A = Age 65–74 years

Sc = Sex category (i.e. female sex)