Atrial Fibrillation (Thera)

Drug formulary

Highlighted DON’T have to know dosing

AFib background

Three Pillars → Treatment approach

What is AFib?

Normal conduction vs AFib conduction

Pathophys

Clinical presentation

Electrocardiogram

EKG: NSR vs AFib

Stroke risk

Blood stasis in atrium → thrombus formation

Echocardiograms

Diagnosis

AFib Staging

Risk factors

Aggressive Risk Factor Modification

What subjective and objective evidence of afib are present in this patient?

What are his primary risk factors for afib?

Symptom management

Rate control

What if patient has Afib and CAD/MI or HF?

Suggest targeting a resting heart rate <80 bpm in patients with

symptomatic AF and left ventricular dysfunction.

Drugs we use/clinical considerations

Rate control - acute setting

Focus on digoxin dosing

Digoxin

RATE CONTROL Strategy

Clinical Pearls of Medications

Amiodarone

Rhythm control

Cardioversion

Electrical cardioversion

Antiocoag before/after cardioversion

Maintenance of sinus rhythm

VW Classifications

Class IA → Quindine

Usually the wrong answer

Class IC → Propafenone and Flecainide

Class IC → “Pill-in-the-Pocket” Approach

Class III → Amiodarone

Amiodarone Drug Interactions

But what if we started amiodarone? Clinical Q earlier

Amiodarone ADRs → “SLEPT NC”

Class III → Dronedarone (Multaq)

Dronedarone contraindications

Class III → Dofetilide (Tikosyn)

Dofetilide (Tikosyn) continued

Class III → Sotalol (Betapace AF)

Ibutilide

RHYTHM CONTROL STRATEGY- (maintenance)

Rate vs Rhythm control

Stroke prevention

CHA2 DS2 VASc Score

Anticoagulant options

CHA2 DS2 VASc Score/Treatment

DOAC Utilization by Race/Ethnicity

Dabigatran (Pradaxa)

Rivaroxaban (Xarelto)

Apixaban (Eliquis)

Edoxaban (Savaysa)

Assessment of bleeding risk

Reversal agents for DOACs

Catheter ablation

Surgical Approaches

RATE CONTROL:

Is Randa meeting her goal ventricular rate?

What other options for rate control could the physician have used?

STROKE PREVENTION:

What is Randa’s CHA2DS2VASc score?

4 (HTN, age, female)

Which medication would you recommend for stroke prevention? Include a

drug, dose, route of administration, and frequency

RHYTHM CONTROL:

What would be the most appropriate antiarrhythmic to

pharmacologically cardiovert Randa? (include dosing)

When would you start this antiarrhythmic and why?

The antiarrhythmic you choose worked and how Randa is back in normal sinus rhythm on the ECG. What would be good options of antiarrhythmic(s) for maintenance of NSR?

A. Sotalol

B. Dronedarone

C. Dofetilide

D. Flecainide

E. Amiodarone