ATRIAL FIBRILLATION

Atrial fibrillation is variable in its presentation, hemodynamic effects and response to therapy. Physicians need to individualize the treatment plan. The benefits and risks of all potential treatments need to be extremely well known so as to provide safe and effective care.

LEARNING OBJECTIVES:

KNOWLEDGE:

  1. Know the differences between Paroxysmal, Persistent and Chronic Atrial fibrillation.
  2. Know the common etiologies of Paroxysmal, Persistent and Chronic Atrial fibrillation.
  3. Describe the hemodynamic consequences of new onset atrial fibrillation.
  4. Have a framework for management focusing on the three main therapeutic goals.
  5. Define the risk of stroke for the patient with persistent or paroxysmal atrial fibrillation.
  6. Define the relative and absolute risk reduction of stroke for coumadin and aspirin.
  7. Develop a plan for safe, elective cardioversion in a patient with afib of unknown or >48 hours duration.
  8. Know the different classes of antiarrhythmics and when they can and can’t be used.
  9. Know the role of a rate control versus rhythm control strategy in afib.
  10. Be aware of the roles of nonpharmacologic therapies such as ablation and device therapy.

PATIENT CARE SKILLS:

  1. Recognize an irregularly irregular rhythm on examination and detect the presence of a pulse deficit.
  2. Correctly diagnose afib on a 12-lead EKG and differentiate it from artifact and other irregular rhythms.
  3. Recognize unstable supraventricular tachycardia and be prepared to proceed with cardioversion,

 

REFERENCES:

  1. ACC/AHA/ ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation—Executive Summary Circulation 2006;114;700-752;

    ***The American Heart Association guidelines for Atrial Fibrillation can be found and downloaded at the following site: http://circ.ahajournals.org/cgi/content/full/114/7/700