Management of Arrhythmias Flashcards
(31 cards)
What are the 4 main indications for rhythm control in AF?
1) Reversible underlying cause
2) New onset (<48hrs)
3) Haemodynamic instability
4) Failure of rate control
How would you treat a patient in haemodynamically unstable AF?
Immediate DC cardioversion under sedation/GA
3 attempts
How would you treat a patient with new onset AF (<48hrs) who is haemodynamically stable?
Immediate DC cardioversion + IV Heparin
Treat underlying cause
How would you treat a patient with AF of >48hrs
Initiate anticoagulation
Rate control in meantime
Consider TOE to exclude atrial thrombus
DC cardioversion after at least 3 weeks of anticoagulation
when would you choose pharmacological rather than DC cardioversion?
In old, frail patients who would not tolerate sedation/GA
If 3x DC cardioversion fails in haemodynamically unstable patients
How long do pacemaker batteries last?
5 years
Give the main indication for single-lead pacemakers. Which chamber is usually paced?
Permanent AF (without ablation)
RV, unless patient is young and has very good AVN conduction
Give 3 indications for a dual-chamber pacemaker and which chambers are paced?
1) Permanent AF - ‘pace and ablate’ strategy
2) Type II 2nd or 3rd degree heart block
3) Symptomatic bradycardia
RA and RV
What is the main indication for a bi-ventricular pacemaker (CRT)? What chambers are paced?
Heart failure with concurrent type II 2nd or 3rd degree heart block
RA, RV and LV
Give 3 indications for an ICD?
Secondary prevention after episode of VT or VF
Primary prevention of VT/VF in patients with:
1) Familial hypertrophic cardiomyopathy
2) zFamilial long-QT syndrome
What ECG changes does a pacemaker generate?
Sharp line before p wave or QRS complex, depending on whether it is single- or dual-chamber
What drug should be used for pharmacological cardioversion in patients with underlying structural heart disease?
Amiodarone
What are the two first-line drugs for pharmacological cardioversion in patients without structural heart disease?
Flecainide and Amiodarone
After successful cardioversion, what drug should be used for long-term rhythm control? What is 2nd line?
1st line = Beta-blockers
2nd line = Dronaderone
What drug should be used for long-term rhythm control in patient with heart failure?
Amiodarone
How would you manage a patient with paroxysmal AF?
Anticoagulation with warfarin or DOAC
Consider ‘pill in pocket’ (Flecainide)
What is the first-line drug for rate control in AF?
Beta-blocker (Atenolol)
What is the 2nd line choice for rate control of AF? When must is this contraindicated?
Diltizem/Verapamil
Avoid in heart failure
What drug may be considered in sedentary patients or those with heart failure?
Digoxin
When should anticoagulation be started in patient with AF?
CHA2DS2-VASc score:
1 or more = males only
2 or more = everyone
What is the target INR for patients with AF receiving Warfarin?
2-3
How would you manage a patient with permanent AF?
‘Pace and ablate’ - catheter ablation of AV node and permanent dual-chamber pacing (RA, RV)
How would you manage a patient with atrial flutter?
As for AF!
Anticoagulation + rhythm control:
DC cardioversion after at least 3 weeks of anticoagulation + long-term rhythm control with 1st line = beta-blockers
2nd line = amiodarone
Anticoagulation + rate control:
1st line = beta-blokers
2nd line = verapamil
3rd line = digoxin
What is the acute and long-term management of SVT?
ACUTE (stable):
Vagal manoeuvres
IV Adenosine
ACUTE (unstable):
DC cardioversion
LONG TERM:
Beta-blockers
Catheter ablation
