Atrial fibrillation

Question 1

What are key differences in management of A.fib vs A.flutter?

Answer 1

1) It is difficult to achieve heart rate control with atrial flutter than a-fib
2) Threshold of using catheter ablation is lower for atrial flutter than atrial fibrillation

Question 2

When do we opt for cardioversion?

Answer 2

In cases where the tachycardia produces hemodynamic compromise, heart failure or angina
In such cases, the tachycardia should be terminated electrically

Question 3

WHEN do we initiate an anticoagulant in those with atrial flutter or fibrillation going for cardioversion?

Answer 3

if the atrial flutter or a.fib lasted >48 hrs, then the person should be anti coagulated for at least 3 weeks prior to electrical cardioversion

Adequate anticoagulation should be maintained for a minimum of 4 weeks after cardioversion

Question 4

When do we consider catheter ablation first line option?

Answer 4

In atrial flutter, as catheter ablation has a success rate of about 95% with low rate of complications

In atrial fibrillation, in patients who are symptomatic and do NOT want to remain on anti-arrhythmias long-term

In A-fib, success rate is usually 50-80% and unlike atrial flutter, Ablation in A-fib does not result in complete cure

Ablation success in A-fib also depends on A-fib type, structural heart disease

Success rate is highest in patients with paroxysmal A-fib and lowest in patients with persistent A-fib

Question 5

How do choose between rate vs rhythm control for Atrial fibrillation?

Answer 5

rhythm control: 
1- for Asymptomatic young patients, 
2- in those with possible tachycardia-related cardiomyopathy
3- multiple recurrences
4- Extreme impairment in QoL
5- highly symptomatic 

There is NO significant difference in risk of stroke or mortality between the two methods