Atrial Fibrillation Management || A+ Certified.
Atrial Fibrillation correct answers supraventricular tachyarrhythmia characterized by an
irregularly irregular rhythm secondary to fibrillating atria (300-600 bpm) followed by erratic but
rapid ventricular responses (100-180 bpm)
ECG presentation of A fib correct answers irregularly irregular rhythm, variable R-R intervals,
no discernable P waves before each QRS complex
Pathophys of a fib correct answers rapidly firing atrial foci (enhanced automaticity) near
pulmonary veins in LA or coronary sinus, atrial pathology, multiple reentrant wavelets, sleep
apnea, thyrotoxicosis
Paroxysmal atrial fibrillation correct answers atrial fibrillation that terminates spontaneously or
with intervention within 7 days of onset, episodes may recur with variable frequency
Persistent atrial fibrillation correct answers continuous af that is sustained greater than 7 days
Long-standing persistent a fib correct answers continuous a fib >12 mo in duration
Permanent a fib correct answers used when patient and clinician make joint decision to stop
further attempts to restore and/or maintain sinus rhythm, acceptance of a fib represents a
therapeutic attitude on the part of the patient and clinician rather than an inherent pathophys
attribute of AF, acceptance of AF may change as symptoms, efficacy of therapeutic
interventions, and patient and clinican preferences evovle
Nonvalvular a fib correct answers a fib in the absence of rheumatic mitral stenosis, a mechanical
or bioprosthetic heart valve, or mitral valve repair
Lone AF correct answers individuals <60 yo without clinical or echocardiographic evidence of
cardiopulmonary disease, HTN, or other cardiac structural disease
CAD correct answers dofetilide, dronedarone, or sotalol
HF correct answers amiodarone or dofetilide
Control of ventricular rate using a beta blocker or nonDHP CCB is recommeded for correct
answers patients with paroxysmal, persistent, or permanent atrial fibrillation
IV admin of beta blocker of nondhp ccb is recommended to correct answers slow ventricular
heart rate in the acute setting in patients without pre-excitation, in hemodynamically unstable
patients prefer electrical cardioversion
In patients who experience AF-related sx during activity, correct answers the adequacy of heart
rate control should be assessed during exertion, adjusting pharmacological treatment as
necessary to keep the ventricular rate within the physiological range
, A heart rate control strategy is correct answers reasonable for symptomatic management of AF
(resting heart rate of <80bpm)
IV amiodarone can be useful for correct answers rate control in critically ill patients without pre-
excitation
AV nodal ablation with permanent ventricular pacing is reasonable to correct answers control
heart rate when pharmacological therapy is inadequate and rhythm control is not achievable
A lenient rate-control strategy correct answers (resting hr <110) may be reasonable as long as
patients remain asymptomatic and LV systolic function is preserved
Oral amiodarone may be useful for correct answers ventricular rate control when other measures
are unsuccessful or contraindicated
AV nodal ablation with permanent ventricular pacing should not be performed to correct answers
improve rate control without prior attempts to achieve rate control with medications
Nondhp CCAs should not be used in patients with correct answers decompensated HF as these
may lead to further hemodynamic compromise
In patients with pre-excitation and AF correct answers digoxin, nondhp CCA, or IV amiodarone
should not be administered as they may increase the ventricular response and may result in
ventricular fibrillation
Rate control no other CV disease correct answers beta blocker, diltiazem, verapamil
Rate control with hypertension or HFpEF correct answers beta blocker, diltiazem, or verapamil
Rate control with LV dysfunction of HF correct answers beta blocker, digoxin
Rate control with COPD correct answers beta blocker, diltiazem, verpamil
In pursuing a rhythm-control strategy, cardioversion is recommended for patients with correct
answers AF or atrial flutter as a method to restore sinus rhythm
if cardioversion is unsuccessful, repeated attempts at direct-current cardioversion may be made
after adjusting the location of the electrodes, applying pressure over the electrodes, or following
admin of an antiarrhythmic medication
Cardioversion is recommended when correct answers a rapid ventricular response to AF or atrial
flutter does not respond promptly to pharmacological therapies and contributes to ongoing
myocardial ischemia, hypotension, or HF
Cardioversion is recommended for patients with AF or atrial flutter and pre-excitation when
correct answers tachycardia is associated with hemodynamic instability
Atrial Fibrillation correct answers supraventricular tachyarrhythmia characterized by an
irregularly irregular rhythm secondary to fibrillating atria (300-600 bpm) followed by erratic but
rapid ventricular responses (100-180 bpm)
ECG presentation of A fib correct answers irregularly irregular rhythm, variable R-R intervals,
no discernable P waves before each QRS complex
Pathophys of a fib correct answers rapidly firing atrial foci (enhanced automaticity) near
pulmonary veins in LA or coronary sinus, atrial pathology, multiple reentrant wavelets, sleep
apnea, thyrotoxicosis
Paroxysmal atrial fibrillation correct answers atrial fibrillation that terminates spontaneously or
with intervention within 7 days of onset, episodes may recur with variable frequency
Persistent atrial fibrillation correct answers continuous af that is sustained greater than 7 days
Long-standing persistent a fib correct answers continuous a fib >12 mo in duration
Permanent a fib correct answers used when patient and clinician make joint decision to stop
further attempts to restore and/or maintain sinus rhythm, acceptance of a fib represents a
therapeutic attitude on the part of the patient and clinician rather than an inherent pathophys
attribute of AF, acceptance of AF may change as symptoms, efficacy of therapeutic
interventions, and patient and clinican preferences evovle
Nonvalvular a fib correct answers a fib in the absence of rheumatic mitral stenosis, a mechanical
or bioprosthetic heart valve, or mitral valve repair
Lone AF correct answers individuals <60 yo without clinical or echocardiographic evidence of
cardiopulmonary disease, HTN, or other cardiac structural disease
CAD correct answers dofetilide, dronedarone, or sotalol
HF correct answers amiodarone or dofetilide
Control of ventricular rate using a beta blocker or nonDHP CCB is recommeded for correct
answers patients with paroxysmal, persistent, or permanent atrial fibrillation
IV admin of beta blocker of nondhp ccb is recommended to correct answers slow ventricular
heart rate in the acute setting in patients without pre-excitation, in hemodynamically unstable
patients prefer electrical cardioversion
In patients who experience AF-related sx during activity, correct answers the adequacy of heart
rate control should be assessed during exertion, adjusting pharmacological treatment as
necessary to keep the ventricular rate within the physiological range
, A heart rate control strategy is correct answers reasonable for symptomatic management of AF
(resting heart rate of <80bpm)
IV amiodarone can be useful for correct answers rate control in critically ill patients without pre-
excitation
AV nodal ablation with permanent ventricular pacing is reasonable to correct answers control
heart rate when pharmacological therapy is inadequate and rhythm control is not achievable
A lenient rate-control strategy correct answers (resting hr <110) may be reasonable as long as
patients remain asymptomatic and LV systolic function is preserved
Oral amiodarone may be useful for correct answers ventricular rate control when other measures
are unsuccessful or contraindicated
AV nodal ablation with permanent ventricular pacing should not be performed to correct answers
improve rate control without prior attempts to achieve rate control with medications
Nondhp CCAs should not be used in patients with correct answers decompensated HF as these
may lead to further hemodynamic compromise
In patients with pre-excitation and AF correct answers digoxin, nondhp CCA, or IV amiodarone
should not be administered as they may increase the ventricular response and may result in
ventricular fibrillation
Rate control no other CV disease correct answers beta blocker, diltiazem, verapamil
Rate control with hypertension or HFpEF correct answers beta blocker, diltiazem, or verapamil
Rate control with LV dysfunction of HF correct answers beta blocker, digoxin
Rate control with COPD correct answers beta blocker, diltiazem, verpamil
In pursuing a rhythm-control strategy, cardioversion is recommended for patients with correct
answers AF or atrial flutter as a method to restore sinus rhythm
if cardioversion is unsuccessful, repeated attempts at direct-current cardioversion may be made
after adjusting the location of the electrodes, applying pressure over the electrodes, or following
admin of an antiarrhythmic medication
Cardioversion is recommended when correct answers a rapid ventricular response to AF or atrial
flutter does not respond promptly to pharmacological therapies and contributes to ongoing
myocardial ischemia, hypotension, or HF
Cardioversion is recommended for patients with AF or atrial flutter and pre-excitation when
correct answers tachycardia is associated with hemodynamic instability
