CC Jan 2018 Atrial fibrillation Rate vs. Rhythm control

echoecho's version from 2018-02-28 04:51


Question Answer
Define AF?a supraventricular arrhythmia affecting 2.5 million patients in the US
Characteristics of AF?uncoordinated atrial contractility which manifests as an irregularly irregular rhythm
List the risk factors of AF?1) HTN 2) atherosclerotic heart disease 3) MI 4) heart failure 5) pulmonary disease 6) DM 7) sleep apnea 8) smoking 9) obesity 10) hyperthyroidism 11) older age 12) genetic factors
True or false? AF is the most common arrhythmia seen in clinical practice?true
AF can be asymptomatic, particularly in individuals > ____ y.o.?65
AF can manifest symptoms such as?1) dyspnea 2) palpitations 3) fatigue 4) dizziness 5) syncope
AF is associated with a ___-fold increased incidence of stroke and many AF patients require what medication?1) five 2) anticoagulation
What are persistent issues in the treatment of AF?1) suboptimal use of anticoagulant therapy by physicians 2) problems with adherence to anticoagulation therapy by the patient
List the 4 classifications of AF by the AHA / ACC?1) Paroxysmal (with AF episodes that stop spontaneously, usually w/in 24 hours but may last up to 7 days and have a variable recurrence rate) 2) Persistent (AF episodes that last > 7 days and may require intervention) 3) Longstanding, persistent (AF lasting > 12 months usually because of failed cardioversion or if cardioversion has not been attempted) 4) Permanent
True or false? AF associated with rapid ventricular response (so-called AF with RVR) tends to be more symptomatic than AF associated with a normal ventricular response?true
As part of the therapeutic approach to AF, physicians and patients must decide between what?rhythm control (an attempt to restore normal sinus rhythm) and rate control (allowing AF to continue but without RVR)
What factors may influence the decision between rhythm control vs. rate control?1) patient preference 2) age 3) comorbidity 4) access to subspecialist care 5) patient adherence to treatment plans
List the antiarrhythmic drugs that have been used to attempt to restore sinus rhythm?1) flecainide (Tambocor) 2) propafenone (Rythmol) 3) amiodarone (Cordarone 4) dofetilide (Tikosyn) 5) dronedarone (Multaq) 6) sotalol (Betapace)
What are the 2 disadvantages of antiarrhythmic drugs?1) significant side-effects 2) efficacy in restoring sinus rhythm is modest (multiple drugs are often needed0
Compare catheter ablation and antiarrhythmic drugs?antiarrhythmic drugs are LESS effective at achieving and maintaining sinus rhythm (60-70% incidence of recurrent AF with drug therapy vs. 11-13% recurrence after catheter ablation)
Catheter ablation is being used with increasing frequency as a primary treatment for AF, especially in what type of patients?younger patients
When is rate control used in AF treatment?when restoration of sinus rhythm is NOT deemed necessary and the goal is to minimize AF symptoms, rate control, often used concurrently with anticoagulation
*** In the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) and the Rate Control vs. Electrical Cardioversion Study (RACE), what was the findings?In both investigations, there was NO significant difference in outcomes between rate control and rhythm control
What are the preferred drugs for RATE control?1) beta-blockers 2) nondihydropyridine calcium channel blockers (verapamil (Calan), diltiazem (Cardizem)
The AHA/ACA recommends a target resting heart rate of < ____beats per minute (Class IIa) with a consideration for a more lenient resting heart rate of < ____ beats per minute (IIb)?80; 110
*** SUMMARY = AF is a common ______ ventricular arrhythmia?supra
*** SUMMARY = Long-term _______ is often necessary to prevent embolic stroke?anticoagulation
*** SUMMARY = Is there significant difference in outcomes between rate control and rhythm control?no
*** SUMMARY = What medications are most commonly used for rate control in AF?1) beta-blocker 2) nondihydropyridine calcium channel blockers