Atrial Fibrillation

Question 1

What is the most common SUSTAINED arrhythmia?

Answer 1

Atrial Fibrillation

Question 2

What are the characteristics of Atrial Fibrillation?

Answer 2

1. Disorganized
2. Rapid
3. Irregular atrial activation

Question 3

With irregular ventricular rate that is determined by?

Answer 3

AV Nodal conduction

Question 4

In AF, prevalence increases with age with?

Answer 4

95% over the age of 60 years old

Question 5

Prevalence by age of 80?

Answer 5

10%

Question 6

Lifetime risknof developing AF among MEN at the age of 40 years?

Answer 6

25%

Question 7

Prevalence of AF by Sex

Answer 7

Men > Women

Question 8

Prevalence of AF by race

Answer 8

Whites > Blacks

Question 9

AF accounts in ______% of strokes

Answer 9

25%

Question 10

AF increases risk of _________ and _______ detected by MRI

Answer 10

Dementia and Silent Stroke

Question 11

AF episodes that SELF-TERMINATE or cardiovert in < 7 days

Answer 11

Paroxysmal AF

Question 12

AF episodes that DO NOT self terminate in less than 7 days?

Answer 12

Persistent AF

Question 14

Persistent AF of >1 year

Answer 14

Long Standing AF

Question 15

Efficacy of Anti-arrhythmic drugs is often effective at what kind of AF?

Answer 15

Paroxysmal AF

Question 16

Clinical presentation and manifestation of AF results from?

Answer 16

1. Irregular and often rapid ventricular rates
2. Hemodynamic changes with altered cardiac function
3. Effects of cardioembolic phenomena

Question 17

General pathophysiologies of AF

Answer 17

1. Loss of atrial contribution to ventricular filling
2. Rapid Ventricular rates

Question 18

In AF, Loss of atrial contribution to ventricular filling and Rapid Ventricular rates will result to?

Answer 18

Predisposition to thrombus formation at the LEFT ATRIAL APPENDAGE with risk of EMBOLIZATION

Question 20

If patient with AF has impaired cardiac function (E.g HOCM, HF with preserved EF) this will lead to?

Answer 20

1. Rapid ventricular rate
2. Heart Failure

Question 21

AF terminating to sinus rhythm can cause pauses that can lead to?

Answer 21

Dizziness or syncope

Question 22

Seeb in ventricular rate of >100bpm among asymptomatix patients (no palpitations)

Answer 22

Tachycardia related - CMP

Question 23

Tachycardia related CMP is reversible if we control the?

Answer 23

Ventricular rate

Question 24

AF treatment aims to

Answer 24

1. Control symptoms through rate control and/or rhythm control
2. Mitigation of thromboembolic risk
3. Addressing modifiable risk factors for progression of AF

Question 25

What are the option if patient had unstable acute onset AF (Severe hypotension, pulmonary edema)

Answer 25

1. Electrical cardioversion of 200J 2. Pharmacologic cardioversion of IV ibutilide

Question 26

IV Ibutilide is avoided in patients with ___________ or _________given the risk of torsades de pointes

Answer 26

1. Baseline prolonged QT interval 2. Severe LV dysfunction

Question 28

In stable AF what would be the interventions?

Answer 28

1. Rate control 2. Anticoagulation to decrease stroke risk

Question 29

AF duration is unclear or > 48 hours what whould be the management?

Answer 29

Anticoagulation before cardioversion

Question 30

In AF what is the major source of thromboembolism and stroke?

Answer 30

Left atrial appendage thrombus

Question 31

Despite successful cardioversion of prolonged AF, thrombi can still form as _______________ can be delayed for weeks

Answer 31

Atrial Mechanical Function

Question 32

Cardioversion in the absence of anticoagulation may be done if low risk for thromboembolism (No prior embolic episodes, not rheumatic MS or HCMP with marked LAE) in AF of?

Answer 32

<48hrs

Question 33

2 approaches to mitigate risk related to cardioversion

Answer 33

1. Anticoagulate continuesly for 3 weeks and a minimum of 4 weeks after cardioversion 2. Start anticoagulation and do TEE to check thrombus in LA appendage

Question 34

If TEE was done and no thrombus was seen in the LA appendage what would be the management

Answer 34

Cardiovert then anticoagulate in >=4 weeks to allow recovery of atrial function

Question 35

Choice of rate control in Acute AF

Answer 35

1. BB and/or Non DHP CCB (IV or Oral) 2. May add digoxin if with heart failure Goal: <100bpm

Question 36

Choice of rate control in Chronic AF

Answer 36

Beta blockers and/or Non-DHP may add Digoxin if with HF

Question 37

Goal of controlling HR in Atrial Fibrillation

Answer 37

1. Resting HR of <80bpm that increases to <100bpm with LIGHT EXCERSION (e.g walking) 2. Resting HR of <110bpm if no symptoms + normal ventricular function

Question 38

In Chronic AF, if adequate control is not achieved what would be the next step?

Answer 38

May consider restoring to sinus rhythm by catheter ablation + placement of permanent pacemaker

Question 39

Stroke Prevention in AF

Answer 39

Anticoagulation