Atrial Fibrillation (AF)

3/26/25, 10:02 AM OneNote Atrial Fibrillation (AF) Wednesday, March 12, 2025 8:55 PM Topic Discussion: Atrial Fibrillation (AF) (10 minutes) 1. Background/Introduction a. Introduction: Atrial fibrillation (AF) is the most common form of cardiac arrhythmia, marked by irregular electrical activity in the atria, leading to ineffective contraction, an increased risk of stroke, and potential heart failure. b. Epidemiology: AF affects about 2-3% of the global population, with the prevalence increasing with age. It is a major cause of morbidity and mortality, contributing significantly to stroke and heart failure. c. Different types/classifications of the disease: • Paroxysmal: AF that starts and stops spontaneously within 7 days. • Persistent: AF lasting more than 7 days but can be terminated with treatment. • Permanent: Chronic AF that cannot be reverted to normal sinus rhythm. d. Risk Factors (3 for full points): • Hypertension, heart failure, diabetes, smoking, excessive alcohol use, obesity 2. Pathophysiology/Etiology • The atrial tissue becomes electrically unstable, causing rapid and disorganized electrical signals. This leads to ineffective atrial contraction, reduced cardiac output, and potential thromboembolic complications (e.g., stroke). 3. Signs and Symptoms a. Pertinent Labs: ECG shows an irregularly irregular rhythm with no distinct P waves. Blood tests can check thyroid function (hyperthyroidism can trigger AF) and assess renal and liver function. b. Presenting Symptoms (3 for full points): Palpitations, fatigue, shortness of breath, dizziness, chest pain, and signs of stroke (e.g., face droop, feeling numb, slurred speech). c. Assessment/diagnostic criteria/tools: ECG, echocardiography, and clinical scoring systems (e.g., CHA2DS2-VASc for stroke risk). 4. Treatment a. Approach to Therapy i. Non-pharmacological (2 for full points, 1 for half) • Cardioversion: Electrical or pharmacological (e.g., ibutilide). • Ablation: Catheter ablation for persistent or symptomatic AF unresponsive to medication. ii. Pharmacological (full points: unique clinical pearl for ALL 1st line medication classes/agents) 1. 1st line agents: a. Anticoagulation: Warfarin, apixaban, rivaroxaban, or dabigatran (DOACs). i. Anticoagulation is essential to prevent stroke, while rate or rhythm control aims to reduce symptoms and improve heart function. • No routine monitoring but have specific renal dose adjustments and contraindications (e.g., in patients with severe renal impairment). b. Rate control: Beta-blockers (e.g., metoprolol), calcium channel blockers (e.g., diltiazem), and digoxin. • BBs – Can cause bradycardia and hypotension; monitor heart rate and blood pressure c. Rhythm control: Antiarrhythmics like amiodarone or flecainide. 2. 2nd line agents: a. Sotalol or propafenone for rhythm control if first-line agents are ineffective. Duration of therapy: https://americancareercollege-my.sharepoint.com/personal/cvo1_u_westcoastuniversity_edu/_layouts/15/Doc.aspx?sourcedoc={5ba16cd8-9933-4504-ade5-0b389535a42c}&action=view&wd=target%28Topic Presentation.… 1/2 3/26/25, 10:02 AM OneNote Long-term anticoagulation is often required for stroke prevention. Rhythm or rate control therapy continues as needed to manage symptoms. 5. Possible Questions from Evaluators (5 minutes) • Drug Questions: • Brand/Generic: Apixaban (Eliquis), rivaroxaban (Xarelto). • Counseling Points: Emphasize the importance of regular INR monitoring with warfarin; DOACs do not require routine monitoring. • Monitoring: Monitor renal function and INR (for warfarin). • Drug-Drug Interactions: DOACs and warfarin interact with various drugs, including antiplatelets and antifungals. • ADR: Bleeding is a significant concern for all anticoagulants. • Contraindications: Avoid in patients with active bleeding or severe renal impairment. • Duration of therapy: Lifelong anticoagulation in patients with high stroke risk. • MOA: DOACs inhibit thrombin or factor Xa, preventing clot formation. • Follow-up: Regular assessment of stroke risk and anticoagulation efficacy. Guideline: 2019 AHA/ACC/HRS Atrial Fibrillation Guidelines https://americancareercollege-my.sharepoint.com/personal/cvo1_u_westcoastuniversity_edu/_layouts/15/Doc.aspx?sourcedoc={5ba16cd8-9933-4504-ade5-0b389535a42c}&action=view&wd=target%28Topic Presentation.… 2/2