Atrial Fibrillation Flashcards
(38 cards)
What are the classifications of atrial fibrillation (AF)?
AF may be classified as:
* first detected episode
* paroxysmal
* persistent
* permanent
First detected episode refers to the initial occurrence of AF, regardless of symptoms or termination. Paroxysmal AF terminates spontaneously and lasts less than 7 days, while persistent AF does not terminate on its own and lasts longer than 7 days. Permanent AF is continuous and cannot be cardioverted.
What is the definition of paroxysmal AF?
Paroxysmal AF is defined as episodes of AF that terminate spontaneously and last less than 7 days, typically less than 24 hours.
This classification is used when the arrhythmia self-terminates.
What defines persistent AF?
Persistent AF is characterized by episodes that do not terminate spontaneously and usually last greater than 7 days.
It requires intervention to restore normal rhythm.
What is permanent AF?
Permanent AF is continuous atrial fibrillation that cannot be cardioverted or where attempts to do so are deemed inappropriate.
Treatment focuses on rate control and anticoagulation.
What should be done if AF is less than 48 hours old?
Patients should be heparinised and may be cardioverted using either:
* electrical - DC cardioversion
* pharmacological - amiodarone, flecainide, or amiodarone without structural heart disease
Cardioversion may not require anticoagulation if AF is confirmed to be less than 48 hours duration.
What is the recommended action for patients with AF lasting more than 48 hours?
Anticoagulation should be given for at least 3 weeks prior to cardioversion.
An alternative strategy includes performing a transoesophageal echo (TOE) to exclude a left atrial appendage (LAA) thrombus.
What does NICE recommend for electrical cardioversion?
NICE recommends electrical cardioversion over pharmacological cardioversion in cases of AF lasting less than 48 hours.
This is particularly true if there is a high risk of cardioversion failure.
What are the two key parts of managing patients with AF?
The two key parts are:
* Rate/rhythm control
* Reducing stroke risk
These strategies are crucial for effective management of AF.
What is the difference between rate control and rhythm control?
Rate control aims to slow the heart rate while accepting an irregular pulse, whereas rhythm control aims to restore and maintain normal sinus rhythm.
Cardioversion can be achieved through pharmacological means or electrical shocks.
What is the first-line treatment for rate control in AF?
A beta-blocker or a rate-limiting calcium channel blocker (e.g., diltiazem) is used first-line for rate control in AF.
This approach helps manage the heart rate effectively.
What should be done if one drug does not adequately control the rate in AF?
Combination therapy with any two of the following is recommended:
* beta-blocker
* diltiazem
* digoxin
This strategy can enhance rate control.
What is the recommendation following a stroke or TIA before starting anticoagulation?
It is important to exclude a hemorrhage before starting any anticoagulation or antiplatelet therapy.
This ensures patient safety and appropriate treatment.
When should anticoagulation for AF start after a TIA?
Anticoagulation for AF should start immediately once imaging has excluded hemorrhage following a TIA.
This is crucial for preventing further complications.
When should anticoagulation therapy be initiated after an acute stroke?
Anticoagulation therapy should be commenced after 2 weeks in the absence of hemorrhage, with antiplatelet therapy in the intervening period.
This timing helps manage stroke risks effectively.
What is the CHA2DS2-VASc score used for?
The CHA2DS2-VASc score is used for determining long-term anticoagulation for patients with new-onset AF.
It assesses stroke risk factors.
What does NICE recommend for patients with AF who have not responded to antiarrhythmic medication?
NICE recommends the use of catheter ablation for those with AF who have not responded to or wish to avoid antiarrhythmic medication.
Catheter ablation can be an effective alternative treatment.
Fill in the blank: For patients with AF, if there is a high risk of cardioversion failure, it is recommended to have at least _____ weeks of amiodarone or sotalol prior to electrical cardioversion.
4
This recommendation is based on improving the success rate of cardioversion.
True or False: Patients with AF lasting less than 48 hours do not require anticoagulation after electrical cardioversion.
True
Anticoagulation is unnecessary if AF is confirmed to be less than 48 hours duration.
What is the recommended anticoagulation duration following electrical cardioversion?
Patients should be anticoagulated for at least 4 weeks following electrical cardioversion.
Decisions about future anticoagulation should be based on the risk of recurrence.
What are the classifications of atrial fibrillation (AF)?
AF may be classified as:
* first detected episode
* paroxysmal
* persistent
* permanent
First detected episode refers to the initial occurrence of AF, regardless of symptoms or termination. Paroxysmal AF terminates spontaneously and lasts less than 7 days, while persistent AF does not terminate on its own and lasts longer than 7 days. Permanent AF is continuous and cannot be cardioverted.
What is the definition of paroxysmal AF?
Paroxysmal AF is defined as episodes of AF that terminate spontaneously and last less than 7 days, typically less than 24 hours.
This classification is used when the arrhythmia self-terminates.
What defines persistent AF?
Persistent AF is characterized by episodes that do not terminate spontaneously and usually last greater than 7 days.
It requires intervention to restore normal rhythm.
What is permanent AF?
Permanent AF is continuous atrial fibrillation that cannot be cardioverted or where attempts to do so are deemed inappropriate.
Treatment focuses on rate control and anticoagulation.
What should be done if AF is less than 48 hours old?
Patients should be heparinised and may be cardioverted using either:
* electrical - DC cardioversion
* pharmacological - amiodarone, flecainide, or amiodarone without structural heart disease
Cardioversion may not require anticoagulation if AF is confirmed to be less than 48 hours duration.
