Atrial Fibrillation

Question 1

Identify the two pathological mechanisms behind atrial fibrillation

Answer 1

• Firing of ectopic foci

- Re-entry circuits due to atrial scarring secondary to any structural abnormality

Question 2

Identify the three classifications of atrial fibrillation

Answer 2

• Paroxysmal: Spontaneous resolution of abnormal firing within 7 days
• Persistent: Resolution of abnormal firing after 7 days
• Permanent: Resolution of abnormal firing is impossible

Question 3

Identify a complication of atrial fibrillation and why it arises

Answer 3

• Stagnant blood causes atrial thrombus formation

- Which may embolise in the systemic circulation

Question 4

Identify three risk factors of atrial fibrillation

Answer 4

• Hypertension
• Myocardial infarction
• Valvular heart disease
• Hyperthyroidism
• Diabetes mellitus

Question 5

Identify three clinical features of atrial fibrillation

Answer 5

• Irregular pulse rate
• Palpitations
• Hypotension
• Syncope
• Dizziness

Question 6

Identify three findings on ECEG

Answer 6

• P waves absent
• QRS complex is regularly irregular
• QRS complexes are normal shape
• F waves

Question 7

Identify a finding on transthoracic echocardiography

Answer 7

• Dilated left atrium

Question 8

Identify a finding on transoesophageal echocardiography

Answer 8

• Atrial thrombus

Question 9

When is emergency electrical cardioversion performed?

Answer 9

• Signs of haemodynamic instability
• Pulse > 150 bpm
• Systolic BP < 90 mmHg

Question 10

Identify the first line treatment for haemodynamically stable

Answer 10

• Rate control

WITH

• Beta blocker (atenolol)

OR

• Rate limiting calcium channel blocker (verapamil, diltiazem)

Question 11

What is the second line treatment of AF in haemodynamically stable patients

Answer 11

• Rhythm control

WITH

• Electrical cardioversion

OR

• Pharmacological cardioversion (amiodarone or flecainide)

Question 12

What is the criteria for rhythm control with electrical cardioversion?

Answer 12

• Anticoagulated for 3 months prior

- If this is not possible give LMWH

Question 13

What medication is prescribed for 12 months following electrical cardioversion

Answer 13

• Amiodarone

Question 14

Identify the first line treatment for long term rhythm control in AF

Answer 14

• Beta blocker

Question 15

Identify the second line treatment for long term rhythm control in AF

Answer 15

• Dronaderone

Question 16

What is the criteria for long-termanticoagulation therapy in AF?

Answer 16

• CHA2DS2VASc score of 2 or above

Question 17

Identify three examples of anticoagulants used in AF

Answer 17

• Apixaban
• Edoxaban
• Dabigatran
• Rivaroxaban
• Warfarin

Question 18

How is bleeding risk assessed when on anticoagulation therapy?

Answer 18

• HAS-BLED score

Question 19

What is an alternative to anticoagulation therapy if it is contraindicated or not tolerated?

Answer 19

• Left atrial appendage occlusion

Question 20

Identify a surgical procedure used for long term rhythm control if medication fails?

Answer 20

• Left atrial catheter ablation

Question 21

When is a pacing considered in AF?

Answer 21

• Those with permanent AF