Atrial Fibrillation

Question 1

What are the 4 types of AF (Classification of AF)

Answer 1

Acute, Paroxysmal, Persistent, Permanent

Question 2

What is defined as Paroxysmal AF and Persistent AF?

Answer 2

Paroxysmal AF - 2 or more episodes less than 48 hours duration
Persistent AF – longer than 7 days

Question 3

What is the treatment of all patients with life-threatening haemodynamic instability caused by new-onset atrial fibrillation?

Answer 3

Emergency electrical cardioversion

Question 4

In patients presenting acutely but without life-threatening haemodynamic instability, what is the type of treatment suggested if onset is >48 hours? Rate or rhythm control

Answer 4

rate or rhythm control can be offered if the onset of arrhythmia is less than 48 hours; rate control is preferred if onset is more than 48 hours or uncertain.

Question 5

What are the drug options for pharmacological cardioversion?

Answer 5

IV Amiodarone hydrochloride

or Flecainide acetate.

Question 6

Which pharmacological cardioversion drug is preferred if there is structural heart disease?

Answer 6

amiodarone hydrochloride is preferred if there is structural heart disease

Question 7

What should be ensured before giving electrical cardioversion?

Answer 7

Do not attempt electrical cardioversion until the patient has been 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

Question 8

What is to be ruled out immediately before an electrical cardioversion?

Answer 8

Absence of a left atrial thrombus

Question 9

What is the preferred first line drug treatment strategy for AF? Rate or rhythm control?
What are the exceptions?

Answer 9

Rate control.
• New-onset atrial fibrillation
• Heart failure secondary to atrial fibrillation
• Atrial flutter suitable for an ablation strategy
• Atrial fibrillation with a reversible cause
or
If rhythm control is more suitable based on clinical judgement.

Question 10

What rate control medications are given if rate control is needed urgently?

Answer 10

Beta blocker (not Sotalol) or Verapamil hydrochloride

Question 11

What medications are given in rate control?

Answer 11

Beta blocker (not Sotalol),
Calcium channel blocker -  Verapamil hydrochloride. Diltiazem is unlicensed.
Digoxin - for sedentary patients

Question 12

What is “pill-in-the-pocket” approach in AF?

What type of AF may use this treatment method?

Answer 12

Pill-in-the-pocket approach involves the patient taking oral flecainide acetate or propafenone hydrochloride to self-treat an episode of atrial fibrillation when it occurs

In paroxysmal AF.

Question 13

Which beta-blocker is not advised for rate control?

Answer 13

Sotalol