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RCE Guidelines Studying > CCS Atrial Fibrillation 2020 > Flashcards

CCS Atrial Fibrillation 2020 Flashcards

1
Q

Who has more Afib men or women?

A

Male (1.5x)

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2
Q

What are 7 triggers for Afib from every day life/substances ?

A
  • stimulants
  • ETOH
  • Sleep deprivation
  • Emotional stress
  • Physical exertion
  • Sleep
  • Digestive
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3
Q

What are the 5 CCSAF scores?

A

0: No symptoms
1: Minimal symptoms
2: Minor effect/Mild awareness
3: Moderate effect, aware on most days
4: Severe impact

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4
Q

What is recommendation for screening?

A

‘Opportunistic screening’ > 65 -> meaning trying to detect AF during medical encounters

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5
Q

In patients with AF what is BP ETOH and OSA recommendation?

A

ETOH 1 or less drink per day

OSA (AHI > 15/hour) -> CPAP

130/80mmhg at rest and <200/100mmhg

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6
Q

Which two patients population to use VKA instead of DOAC?

A
  • Mechanical valve

- Moderate to severe MS

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7
Q

Screening renal function for patients on OAC?

A

Baseline and then annually

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8
Q

What does CCS recommend for DOAC when CrCl 15-30?

A

Follow normal algorithm (No RCT data though)

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9
Q

How advanced does Liver disease need to be to not use DOAC?

A

Severe, CP score C

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10
Q

How to manage OAC around catheter ablation?

A

Uninterrupted OAC

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11
Q

How to manage OAC after 2 months post ablation if successful?

A

No change -> as per CCS algorithm

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12
Q

What 4 populations on AF to bridge?

A
  • Mechanical valves
  • Moderate-severe MS
  • CHADS 5-6
  • Recent Stroke/TIA
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13
Q

Approach to peri-op with VKA if no bridge?

A

Hold 5 days before, measure INR 1 day before. Proceed if INR < 1.5

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14
Q

Approach to peri-op with VKA if bridge planned?

A

Hold 5 days before, LMWH 3 days before , then LMWH post until therapeutic

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15
Q

When to hold DOACs pre op? (Exclude Dabigatran)

A

-1 day before if low/moderate bleeding risk, 2 days before if high bleeding risk

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16
Q

When to hold Dabigatran pre op if CrCl < 50?

A
  • Last dose 3 days before if low/mod risk

- Last dose 5 days before if high risk

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17
Q

What is Andexanet Alfa reversal agent for?

A
  • Apixaban
  • Edoxaban
  • Rivaroxaban
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18
Q

When to start OAC in acute ischemic stroke with New AF based on severity?

A
  • Mild Stroke (NIHSS < 8) : 3 days
  • Moderate Stroke (NIHSS 8-15) : 6 days
  • Large Stroke (NIHSS > 16) : 12 days
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19
Q

Indications for LAA Occluder?

A
  • Moderate to high risk of stroke

- Absolute CI to OAC

20
Q

5 patient populations to pursue rhythm control

A
  • Recent diagnosed in 1 year
  • highly symptomatic/QOL impairment
  • Multiple recurrences
  • Difficulty with rate control
  • arryhthmia induced CMO
21
Q

Efficacy of DCCV?

22
Q

What is DCCV recommended dosing?

A

150 J biphasic waveform

23
Q

How long to follow patients after provoked Afib?

A

Indefinitely: opportunistic screening

24
Q

9 ways to reduce post op Afib ?

A

Beta blockers

Amio

Sotalol

Atrial overdrive pacing

Magnesium

Posterior Pericardectomy

Colchicine

Statins

Antioxidants

25
What to do in young patients with lone AF ?
EPS to rule out SVT
26
Alternative to Procainamide in WPW AFib?
Ibutilide
27
What are 8 labs that should be ordered in new Afib?
- CBC - Lytes + Mg/Ca - Urea/Cr - TSH - Liver panel - Hba1c - Fasting Lipid Profile - INR + PTT
28
What is weight loss target for patients with Afib?
Lose 10% of body weight to BMI < 27
29
When to dose reduce Apixaban?
2/3: Age > 80 Wt < 60kg Cr > 133
30
When to dose reduce Dabigatran?
Age > 80 Age > 75 with bleeding risk factors CrCl 30-50
31
What is renal dosing for Edoxaban and Rivaroxaban and what is the GFR cut off?
Edoxaban 30mg Riva 15mg eGFR 30-50 Do not use if eGFR < 30 (very little RCT data as per CCS AF 2020)
32
What are the recommendations for length of dual therapy post PCI?
1 to 12 months then continue OAC
33
What was Rivaroxaban dose in PIONEER AF?
15mg
34
How to manage VKA/DOAC when emergent procedure warranted? Semi-Urgent?
Emergent: - VKA: Vitamin K 5-10mg IV, Consider PCC - DOAC: Consider Antidotes, PCC if no antidotes Urgent: Delay surgery 12-24h if possible - VKA: Vitamin K 2.5-5mg IV - DOAC: Defer 12-24h, Idarucizumab for Dabi
35
How to manage VKA around procedure if no bridging? If bridging?
No Bridging: Stop VKA 5 days before, Check INR day before (If INR > 1.5 -> Vitamin K) -> Restart Day 1 after Bridging: Stop VKA 5 days before, LMWH 3 days before, check INR day before -> Restart LMWH day after
36
How to manage DOAC (Non Dabigatran) around OR depending on High vs Low/Mod bleeding risk?
- Low/Mod: Stop DOAC 2 days prior -> Restart day after | - High: Stop DOAC 3 days before -> Restart 2 days after
37
How to manage Dabigatran + CrCl < 50 around OR depending on High vs Low/Mod bleeding risk?
- Low/Mod: Stop 3 days before -> restart day after | - High: Stop DOAC 5 days before -> Restart 2 days after
38
Who should have catheter ablation of Afib?
Symptomatic after an adequate trial of anti arrhythmic therapy in whom a rhythm control strategy is desired
39
When to Ablate AV node when patients are BiV paced?
when BiV pacing < 95% despite maximal AV blockade
40
Patients you would want on rhythm control?
- Symptoms not controlled on rate control (strong recommendation) - New Afib (weak recommendation)
41
When to refer for Catheter Ablation?
- Catheter Ablation in AF patients who are symptomatic after AAD trial and rhythm control strategy still required (Strong recommendation) - First line therapy in selected patients (Weak recommendation)
42
When to anticoagulate for SCAF?
-SCAF > 24 hours for CHADS score > 0
43
5 populations to avoid Class 1c's for pill in pocket?
- LVEF < 40% - Ischemic heart disease (need EST if over age 50) - Preexcitation - Severe hepatic or renal dysfunction (eGFR < 35) - AV block or LBBB or RBBB + LAFB
44
5 populations to avoid Sotalol in?
- Baseline QTc prolongation - eGFR < 40 (Daily dose if eGFR 40-60) - LVEF < 40% (with no ICD) - Multiple RFs for Long QT - High grade AV block
45
How to monitor patient on Sotalol?
ECG at 48-72 hours, DC if Qtc > 500 msec
46
5 populations that Amiodarone should be avoided in?
- High grade AV block - Active hepatitis/significant chronic liver disease - Pulmonary interstitial abnormalities - Pre-existing QTc prolongation - Hypersensitivity to iodine - Concomitant use of strong CYP3A4 inhibitors (Ketocanozole, cyclosporine, Ritonavir, Macrolides)
47
Name 5 populations that Dronedarone should be avoided?
- Permanent AF - LVEF < 40% or clinical HF - Significant conduction system disease - Severe hepatic disease - QTc prolongation - Previous lung or liver injury with Amiodarone

RCE Guidelines Studying (52 decks)

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