Atrial Fibrillation Flashcards
What does Cardioversion do?
Brings sinus rhythm back to normal
What drugs can be used to achieve Pharmacological Cardioversion?
IV/Oral Amiodarone or Flecainide
How is New Onset AF w/ Life Threatening Haemodynamic Instability treated?
Immediate electrical cardioversion w/o delay in using anticoagulants.
What drugs can be used for Urgent Rate Control
IV Beta Blockers or Verapamil
How is AF w/o Life Threatening Haemodynamic Instability treated? (2 answers depending on AF onset time)
Onset <48 hours: Rate or Rhythm
Onset >48 hours: Rate is preferred
How long do Anticoagulants need to be given for in patients who are offered non-immediate (+ onset > 48 hours) electrical cardioversion?
At least 3 Weeks Before Cardioversion, and continued for at least 4 Weeks After Cardioversion.
When is Rate Control NOT used as 1st line therapy?
- New Onset AF
- Atrial Flutter is suitable for ablation surgery
- Reversible AF
- Rhythm Control is more clinically suitable
State the drugs that can be used for Rate Control?
Beta Blockers (Except Sotalol), Verapamil, Diltiazem (Unlicensed), Digoxin.
Who can Digoxin be particularly used for?
Sedentary patients, as Digoxin controls ventricular rate at rest (usually for non-paroxysmal pts), it can also be used as rhythm control therapy in patients who have AF + Heart Failure.
If Rate Control Monotherapy is not enough, what combinations of drugs can be used for Dual Therapy instead?
Beta Blocker, Digoxin and Diltiazem
If ventricular function has diminished, which rate control dual therapy is preferred?
Digoxin + Beta Blocker
When is Rhythm Control used and what is its purpose?
Used when:
- Rate control isn’t working
- Rhythm control is clinically more suitable
Purpose = To maintain sinus rhythm, usually after cardioversion.
What are the 2 types of drugs which can be offered for Rhythm Control?
1) Standard Beta Blocker (not including Sotalol)
2) Anti-Arrhythmic Drugs:
- Flecainide
- Propafenone
- Amiodarone
- Dronedarone
- Sotalol
What is the drug pathway for Rhythm Control post cardioversion?
1st offer Standard Beta Blocker (not including Sotalol), if this is ineffective then oral anti-arrhythmic can be offered.
What is Paroxysmal AF?
AF that is self-limiting (goes in 48 hours in the absence of treatment).
When can Flecainide and Propafenone NOT be used?
Ischaemic or Structural Heart Disease
How is Amiodarone given if used with electrical cardioversion?
Start Amiodarone from 3 Months Before and continued for up to 12 Months After electrical cardioversion.
What is Persistent AF?
Lasts for >7 days and/or would need to cardioversion to restore sinus rhythm.
What drug can be used w/ Left Ventricular Impairment or Heart Failure.
Amiodarone
Describe what kind of therapy can be offered to certain patients who suffer from infrequent episodes of paroxysmal AF?
Pill in the pocket therapy - Patient takes oral Flecainide or Propafenone to self treat whenever episode occurs.
What is the drug pathway for Paroxysmal AF?
1st offer Standard Beta Blocker (not including Sotalol), if this is ineffective then oral anti-arrhythmic such as, Flecainide, Propafenone, Sotalol or Amiodarone can be offered.
Give examples of how Anti-Arrhythmic drugs like Flecainide and Propafenone have limited use in Atrial Flutter?
They can slow atrial flutter so a rate controlling drug e.g. standard beta blocker, verapamil or diltiazem needs to be prescribed.
When can Amiodarone be considered for Atrial Flutter?
If all other drugs are ineffective or contraindicated.
What pneumonic is used to assess need for anticoagulation? What does each letter stand for and what are the corresponding points?
CHA2DS2-VASc C = Congestive Heart Failure (1) H = Hypertension (1) A = Age =/> 75 (2) D = Diabetes (1) S = Stroke, Thromboembolism (2) V = Vascular Disease (1) A = Age 65-74 (1) Sc = Sex Category - Female (1)
