Cardiology - Arrythmias: AF Flashcards
AF Risk Factors:
DEMOGRAPHICS
- western countries
- males
- Caucasians
SYSTEMIC
- Hypertension
- obesity
- OSA
- diabetes
- hyperthyroidism
STRUCTURAL HEART
- HOCM
- Valvular heart disease (esp MS)
- ACS with HF (NOT IHD itself)
OTHER
- hypomagnesaemia (50 times more likely)
- alcohol (esp binge drinking)
Demographic RF for AF
- western countries
- males
- Caucasians
Systemic RF for AF
- Hypertension
- obesity
- OSA
- diabetes
- hyperthyroidism
Structural heart disease RF for AF
- HOCM
- Valvular heart disease (esp MS)
- ACS with HF (NOT IHD itself)
Nonspecific RF for AF
- hypomagnesaemia (50 times more likely)
- alcohol (esp binge drinking)
Definition of paroxysmal AF
Self terminates within 7 days
Persistent
> 7 days
Longstanding persistent
> 12 months
Permanent
Not for rhythm strategies
AF can develop post cardiac surgery.
How often?
When is greatest risk?
When can you stop anti-arrythmics?
Develops in 25%
Greatest risk post op on Day 2 and 3
Usually self-limited
Can stop antiarrythmics by 2-3 months post op
Describe the pathology behind the three phases of AF
Phase 1: Paroxysmal AF
- stretch increases propensity for PULMONARY VEIN focuses to develop due to stretch sensitive ion channels
Phase 2: Persistent AF
- over time there is remodelling of left atrium
Phase 3: Permanent AF
- With more time it is more difficult to maintain sinus due to gross electrical and structural atrial remodelling.
What can prevent AF?
- Manage risk factors
- Mediterranean diet with extra virgin olive oil or mixed nutes
- Being fit
Once you have an episode of AF what NON-PHARMA measures can prevent RECURRENCE?
Weight loss (if >10%) causes SIX TIMES decreased recurrence rate
Increased fitness
When is urgent cardioversion indicated, and when doing it how do you sync the charge?
Indicated urgently if HD compromise
Synchronise the R wave to AVOID R-on-T event which provokes VT
? do you need anticoagulation for AF?
If AF is definitely <48 hours then you don’t need anticoagulation
BUT
If uncertain duration or >48 hours then:
- TOE to look for thrombus in LV
- post chemical cardioversion anticoagulation for 3 weeks
- post-procedure anticoagulation for 4 weeks
Agents with PROVEN EFFICACY for pharmacologic conversion
Amiodarone Flecainide Quinidine Dofetilide Ibutilide Propafenone