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AF tips

AF tips. Rate control. Goals of rate control: # <110 (or better <100) at rest is an acceptable goal if symptoms controlled with such a lenient rate and if LV function is normal (RACE II trial)

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AF tips

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  1. AF tips

  2. Rate control

  3. Goals of rate control: # <110 (or better <100) at rest is an acceptable goal if symptoms controlled with such a lenient rate and if LV function is normal (RACE II trial) # <80 at rest and <115 with moderate exertion if pt is symptomatic with the higher rate target or if impaired LV function

  4. Indications for rhythm control? • AF that is symptomatic despite rate control • Symptomatic first presentation of AF, even if symptoms improved with rate control (give them one chance!) • AF + new HF or severely decompensated HF -AF + new HF always think of the possibility of tachycardia-mediated cardiomyopathy and be aggressive with AF

  5. Otherwise, if symptoms well controlled with rate control, rate control is non-inferior to rhythm control (rate control s associated with same % of hard CV events as rhythm control, with a tend to being slightly better, according to AFFIRM and RACE trials)

  6. Predictors of failure of rhythm control and frequent need to accept permanent AF LA diameter> 5 cm AF persistent>1 yr Previous recurrences of persistent AF requiring≥ 2 cardioversions

  7. CHA2DS2 VAS CHF = 1 point HTN = 1 point Age > 75 yrs = 2 points DM = 1 point Prior Stroke or TIA = 2 points V=Vascular disease (CAD, PAD) A=Age 65-74 S=Sex (female)

  8. Short AF case 1 54 yom presents with shock (BP 75/50, obtunded) AF rate 127 Next step?

  9. AF is secondary to shock state rather than causing shock state, esp. when rate<150 would not DC cardiovert, would look for causes of shock In case of AF + shock state, consider other potential causes of shock before attributing it to AF

  10. Short AF case 2 54 yom, known to have low EF 25%, presents with ADHF (pulmonary edema on CXR). He is found to have AF rate of 120 on ECG Rate control?

  11. Give diuresis and vasodilators  AF rate will improve with HF therapy. AF may even convert to sinus with HF therapy as it un-”streches” the left atrium May give digoxin

  12. Short AF case 3 76 yom, hx of HTN. Asymptomatic Found to have irregular pulse on exam and AF rate of 110 Next step?

  13. Anticoagulation (CHA2DS2-VAS score of 3) Since he is asymptomatic, do not rhythm control Rate control to <100-110

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