Morning Report 12/8/15 Atrial Fibrillation

Thanks to Dr. Wentzein for joining us!

  • Paroxysmal Atrial Fibrillation is defined as intermittent episodes lasting less than 7 days. Persistent Atrial fibrillation lasts > 7 days
  • Indications for cardioversion in Atrial Fibrillation: Hemodynamically unstable, refractory to medical interventions, severe CHF symtpoms, unstable angina
  • The ARISTOTLE trial: In patients with nonvalvular atrial fibrillation and at ≥1 risk factor, apixaban is associated with a greater reduction in rates of stroke or systemic embolism while having a lower rate of lower bleeding than warfarin.
    • CHF, HTN, Age 65-75, DM2, Prior stroke
    • Vascular disease, Age >75, Female
  • In general, don’t combine beta-blockers with calcium channel blockers due to the risk of complete heart block.
  • The AFFIRM trial: In patients with nonvalvular AF, there is no survival benefit between rate and rhythm control.
  • Causes of High Output Heart Failure: Systemic AV Fistulas, hyperthyroidism, anemia, beriberi, psoriasis, sepsis, kidney/liver disease
  • Side-effects of Amiodarone include thyroid disorders, lung toxicity, hepatotoxicity, and corneal deposits
  • For Atrial Fibrillation > 48 hours, start antiocoagulation three weeks before and continue four weeks after DCCV
  • For atrial fibrillation < 48 hours, continue anticoagulation for four weeks
  • The ACUTE trial showed that with TEE guided cardioversion (to evaluate for a thrombus), anticoagulation is still needed

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