Arrhythmias

Question 1

Atrial Fibrillation

Answer 1

-Definition
Lone (single episode)

Paroxysmal (comes & goes)

Persistent (more than 7 days)

Permanent (chronic; sustained)

Question 2

Afib Managment

Answer 2

-HR control
-AC
-Cardioversion +/- TEE
-Rhythm control
-Ablation

Question 3

AC Post Cardioversion

Answer 3

-MI stunning occurs
-AC for minimum 4-6 weeks
-F/up outpatient
-May stop ATC if can prove sustained SR and low risk

Question 4

Afib management w/ rate control

Answer 4

-BB: metoprolol, Atenolol, Esmolol
-CCB: Diltiazem
-Digoxin (alone is adequate)

Question 5

Afib management with rhythm control

Answer 5

-Amiodarone
Dofetilide
Dronederone
Flecainide
Propafenone
Sotalol
-EP consult
-Cardioversion

Question 6

Afib management with procedures

Answer 6

-Ablation
-AV node ablation with pacemaker
-Surgical MAZE procedure
-LAAL: This is done during CABG

Question 7

Other management of Afib

Answer 7

-Check thyroid function
-Treat underlying cause (infection)
-Reduce post op stress
-Modify triggers (etoh, tobacco, drugs, caffeine, stress)
-Weight loss
-Treat HTN, HF, MI, Valve disease
-Screen for OSA

Question 8

Aflutter Tx

Answer 8

Adenosine- ACLS
Agents for heart rate contol
Anticoagulation
Cardioverion (+/- TEE)
If sustained Atrial Flutter, consult Electrophysiology to consider Ablation
Cavotricuspid Isthmus (CTI) Ablation is most common

Question 9

Wolf-Parkinson White Syndrome

Answer 9

-Accessory pathway mediated tachycardia (pre-excitation)
-Tx:
Amiodarone
Procainamide
Consult EP to consider ablation
*NO ADENOSINE (if in AF), DIGOXIN OR AV NODAL BLOCKING AGENTS!!!