173. The Internist's Guide to Atrial Fibrillation (Repeat)
Nov 27, 2022
40:57
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Quick takeaways
Decision between rate and rhythm control in atrial fibrillation depends on stability and symptoms, with considerations for paroxysmal versus persistent AFib.
Pill-in-pocket approach combining antiarrhythmic drug with AV nodal blocker is beneficial for managing infrequent symptomatic AFib episodes effectively.
Deep dives
Management of Atrial Fibrillation by Electrophysiologists
Electrophysiologists play a critical role in managing patients with atrial fibrillation. They are involved in various aspects, including managing difficult AFib cases, advising on anticoagulation, and performing interventions like ablation for symptomatic AF. The decision between rate and rhythm control depends on the stability of AFib and the patient's symptoms, with considerations for paroxysmal versus persistent AFib.
Pill-In-Pocket Approach for AFib Management
The pill-in-pocket approach is beneficial for patients with infrequent but symptomatic AFib episodes. By combining a type 1C antiarrhythmic drug with an AV nodal blocker for as-needed use, patients can manage occasional AFib episodes effectively. This approach is particularly useful for those experiencing a low recurrence burden of AFib.
Role of Electrical Cardioversion in Managing AFib
Electrical cardioversion is recommended for patients with ongoing atrial fibrillation who would benefit from restoring and maintaining sinus rhythm. This method is indicated for continuous AFib and those with left ventricular dysfunction. Understanding when to implement electrical cardioversion is crucial for improving patient symptoms and heart function.
Comparative Analysis of DOACs and Warfarin in AFib Management
Direct oral anticoagulants (DOACs) have shown a 20% reduction in stroke risk compared to warfarin in patients with atrial fibrillation. These agents are considered as safe as warfarin but with a 19% lower risk of major bleeding. DOACs are preferred over warfarin for stroke prevention in AFib, except in cases of mechanical heart valves or significant renal impairment.
In this episode, Dr. Sheliza Halani interviews Dr. Andrew Ha, cardiac electrophysiologist at the University Health Network whose interest and clinical focus is in atrial fibrillation.
They discuss the CCS/CHRS Comprehensive Guidelines for the Management of Atrial Fibrillation, released in 2020.
Host: Dr. Sheliza Halani Guest: Dr. Andrew Ha Sound Editing: We would like to thank Krzysztof Kowalik for producing this episode and editing the audio.