Atrial Fibrillation Management

Question 1

What is Atrial Fibrillation (AF)?

Answer 1

A condition characterized by irregular and often rapid heart rate, which can lead to poor blood flow.

Question 2

What heart rate is associated with haemodynamic instability in AF?

Answer 2

> 150 bpm

Question 3

What are the common symptoms of Atrial Fibrillation?

Answer 3

• Palpitations
• Dizziness
• Shortness of breath (SOB)
• Anxiety
• Chest pain

Question 4

What are some Atrial Fibrilation triggers?

Answer 4

• Pulmonary embolism
• Ischaemia
• Respiratory disease
• Atrial enlargement or myxoma
• Thyroid disease
• Ethanol
• Sepsis or sleep apnoea

Question 5

What are the signs of Atrial Fibrillation during a focused exam?

Answer 5

• Irregularly irregular pulse
• Tachycardia
• +/- haemodynamic instability (HoTN, etc)

Question 6

What laboratory investigations are recommended for Atrial Fibrillation?

Answer 6

• FBC (anaemia, infection)
• U&E (electrolyte abnormalities)
• CRP (inflammation, infection)
• TFTs (hyperthyroidism)
• Troponin (ACS)
• Coag studies
• +/- NT-proBNP (suspicion of HF)

Question 7

What are the key findings on an ECG for Atrial Fibrillation?

Answer 7

• Irregularly irregular rhythm
• Absence of P waves

Question 8

What is the first-line treatment for life-threatening haemodynamic instability in AF?

Answer 8

Electrical cardioversion

Question 9

What should be done if AF has persisted for more than 48 hours before cardioversion?

Answer 9

• Put on interim anticoagulation and rate control for >3 weeks
• Alternatively, perform a Transoesophageal Echocardiogram to exclude a LAA thrombus and cardiovert immediately

Question 10

What medications are used for pharmacological cardioversion (rythym control) in Atrial Fibrillation?

Answer 10

• Flecainide (C/I in structural heart disease)
• Amiodarone

Question 11

When should a patient be anticoagulated after electrical cardioversion?

Answer 11

For >4 weeks

Question 12

What are the first-line and second-line treatments for rate control in Atrial Fibrillation?

Answer 12

• 1st line: BB or a rate-limiting CCB (diltiazem or verapamil)
• 2nd line: Digoxin

Question 13

What heart rate is generally considered sufficient to optimize cardiac output in Atrial Fibrillation?

Answer 13

< 110 bpm

Question 14

What scoring system is used to determine the need for anticoagulation in Atrial Fibrillation?

Answer 14

CHA2DS2-VASc

>/= 2: offer anticoagulation

Question 15

What invasive management options are available for Atrial Fibrillation?

Answer 15

• Left atrial ablation
• Pace and ablate strategy (Pacemaker insertion followed by ablation of the AVN. Leaves patient irreversibly dependent on the pacemaker.)