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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?

A

90%

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
Q

What to do in young patients with lone AF ?

A

EPS to rule out SVT

26
Q

Alternative to Procainamide in WPW AFib?

A

Ibutilide

27
Q

What are 8 labs that should be ordered in new Afib?

A
  • CBC
  • Lytes + Mg/Ca
  • Urea/Cr
  • TSH
  • Liver panel
  • Hba1c
  • Fasting Lipid Profile
  • INR + PTT
28
Q

What is weight loss target for patients with Afib?

A

Lose 10% of body weight to BMI < 27

29
Q

When to dose reduce Apixaban?

A

2/3:

Age > 80
Wt < 60kg
Cr > 133

30
Q

When to dose reduce Dabigatran?

A

Age > 80

Age > 75 with bleeding risk factors

CrCl 30-50

31
Q

What is renal dosing for Edoxaban and Rivaroxaban and what is the GFR cut off?

A

Edoxaban 30mg

Riva 15mg

eGFR 30-50

Do not use if eGFR < 30 (very little RCT data as per CCS AF 2020)

32
Q

What are the recommendations for length of dual therapy post PCI?

A

1 to 12 months then continue OAC

33
Q

What was Rivaroxaban dose in PIONEER AF?

A

15mg

34
Q

How to manage VKA/DOAC when emergent procedure warranted? Semi-Urgent?

A

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
Q

How to manage VKA around procedure if no bridging? If bridging?

A

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
Q

How to manage DOAC (Non Dabigatran) around OR depending on High vs Low/Mod bleeding risk?

A
  • Low/Mod: Stop DOAC 2 days prior -> Restart day after

- High: Stop DOAC 3 days before -> Restart 2 days after

37
Q

How to manage Dabigatran + CrCl < 50 around OR depending on High vs Low/Mod bleeding risk?

A
  • Low/Mod: Stop 3 days before -> restart day after

- High: Stop DOAC 5 days before -> Restart 2 days after

38
Q

Who should have catheter ablation of Afib?

A

Symptomatic after an adequate trial of anti arrhythmic therapy in whom a rhythm control strategy is desired

39
Q

When to Ablate AV node when patients are BiV paced?

A

when BiV pacing < 95% despite maximal AV blockade

40
Q

Patients you would want on rhythm control?

A
  • Symptoms not controlled on rate control (strong recommendation)
  • New Afib (weak recommendation)
41
Q

When to refer for Catheter Ablation?

A
  • 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
Q

When to anticoagulate for SCAF?

A

-SCAF > 24 hours for CHADS score > 0

43
Q

5 populations to avoid Class 1c’s for pill in pocket?

A
  • 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
Q

5 populations to avoid Sotalol in?

A
  • 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
Q

How to monitor patient on Sotalol?

A

ECG at 48-72 hours, DC if Qtc > 500 msec

46
Q

5 populations that Amiodarone should be avoided in?

A
  • 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
Q

Name 5 populations that Dronedarone should be avoided?

A
  • 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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