Atrial fibrillation & atrial flutter (Smarty PANCE)

What is Atrial fibrillation (A-fib)?

Atrial fibrillation (A-fib) is an irregular and often very rapid heart rhythm (arrhythmia) that can lead to blood clots in the heart.

What is the most common risk factor for atrial fibrillation?

Hypertension is the most common risk factor for atrial fibrillation. Atrial fibrillation is the most commonly encountered cardiac arrhythmia.

What are thy symptoms of A-fib?

Symptoms include palpitations and sometimes weakness, effort intolerance, dyspnea, and presyncope

What is seen on an ECG tracing of atrial fibrillation?

An ECG tracing of atrial fibrillation shows an erratic baseline and no discrete P waves, in between irregularly spaced QRS complexes

What is a serious complication associated with atrial fibrillation?

A serious complication associated with atrial fibrillation is thrombotic embolism, due to blood stagnation in the atria

What is used to monitor patients on warfarin therapy for the prevention of thrombotic embolism complicating atrial fibrillation?

INR and prothrombin time are used to monitor patients on warfarin therapy for prevention of thrombotic embolism complicating atrial fibrillation

What is the adjusted-dose warfarin target INR for patients with A-fib?

Adjusted-dose warfarin target INR is 2.5 (range 2-3)

Where do the ectopic impulses causing atrial fibrillation most commonly originate?

The ectopic impulses causing atrial fibrillation most commonly originates from the roots of the pulmonary veins

How is the atrial fibrillation rhythm typically described?

The atrial fibrillation rhythm is described as irregularly irregular

How is paroxysmal atrial fibrillation defined?

Paroxysmal atrial fibrillation is defined as intermittent attacks that resolve spontaneously in less than seven days

How is persistent atrial fibrillation defined?

Persistent atrial fibrillation is defined as atrial fibrillation rhythm that lasts more than seven days

Rate control strategy of managing atrial fibrillation aims to keep the heart rate below what rate?

Rate control strategy of managing atrial fibrillation aims to keep the heart rate below 110 beats per minute

What is the scoring system to assess the risk of stroke in patients with Afib?

Anticoagulation is determined by CHA2DS2-VASc or CHADS2 scoring to assess the risk of stroke

What does CHA2DS2-VASc stand for?

CHA2DS2-VASc:

C-Chronic Heart Failure-1 point

H-Hypertension-1 point

A-Age

D-Diabetes Mellitus-1 point

S-Stroke/TIA-2 points

VA-Vascular disease-1 point

Sc-Gender: Male-0 points: Female- 1 point

What does CHADS2 stand for?

CHADS2:

C-CHF - 1 point

H-HTN - 1 point

A-age > 75 yo - 1 point

D-diabetes - 1 point

S2-(stroke or TIA)- 2 points

How are CHADS2 and CHA2DS2-VASc used to determine which patients should receive anticoagulation?

CHA2DS2-VASc is now preferred over CHADS2

Score 0: No anticoagulation needed

Score 1: Consider anticoagulation (especially if male)

Score ≥ 2: Anticoagulation recommended

When indicated, what class of medication is preferable in patients with atrial fibrillation?

Direct oral anticoagulants or DOAC (eg, dabigatran, rivaroxaban, apixaban, or edoxaban) rather than warfarin for most patients in whom oral anticoagulant therapy is chosen

What are some instances warfarin should be chosen over DOACs in patients with Afib.?

Warfarin is preferable to DOACs in patients with mechanical heart valves, mitral stenosis, unacceptable increase in cost, EGFR < 30 ml/min, on certain medications (ex. phenytoin or certain antiretroviral therapy)

What is atrial flutter?

Atrial flutter is similar to atrial fibrillation, a common disorder that causes the heart to beat in abnormal patterns due to a large atrial reentrant circuit

What are the symptoms of atrial flutter?

Symptoms a atrial flutter are the same as A-fib and include palpitations and sometimes weakness, effort intolerance, dyspnea, and presyncope

Diagnosis of atrial flutter?

The diagnosis of atrial flutter is by ECG. In typical flutter, ECG shows continuous and regular atrial activation with a sawtooth pattern, most obvious in leads II, III, and aVF

Treatment of atrial flutter?

Treatment of atrial flutter is the same as that for A-fib and focuses on ventricular rate control, rhythm control, and prevention of thromboembolism.