Atrial Fibrillation,Pacing and ICDs

Posted by e-Medical PPT
Atrial Fibrillation is the Most common arrhythmia
Accounts for 3- 10% of medical admissions
Is associated with a 6 fold increase in stroke rate
Is associated with a 2 fold increase in mortality from IHD
Prevalence increases as population ages
An ECG should be performed in all patients
Rate control and rhythm control should not be considered mutually exclusive and appropriate anti thrombotic therapy should be used
In pts with permanent AF Beta blockers/Ca Antagonists should be the preferred initial monotherapy, digoxin should be reserved for those predominantly sedentary
Anti-thrombotic therapy should be initiated with minimal delay
Stroke risk algorithm should be used in pts and app thromboprophylaxis given

Persistent AF
Either rhythm or rate control strategy
If decision taken to go for rhythm control treat precipitants first
Electrical vs. pharmacological Cardioversion
No difference between these if duration less 48hrs
If combination used then PCV+ECV more successful than ECV+PCV
If AF of <48hrs Pharmacological Cardioversion If AF of >48hrs then electrical Cardioversion

Pharmacological Cardioversion
In the absence of structural heart disease (IHD or LVSD) a class 1c drug such as Flecainide or Propafenone should be drug of choice
In the presence of structural heart disease Amiodarone should be drug of choice
When pts with AF undergo ECV and there is a cause for heightened concern about success of restoring SR (prev failure or early recurrence) then concomitant Amiodarone or Sotolol for 4 weeks should be given...

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