Acute Atrial Fibrillation: What we do.

In this podcast we go on the patient journey, of a 61 yo patient who presents at 11pm at night with an irregularly irregular pulse, at a rate of 167 bpm and a complaint of palpitations.

How do you manage these patients?

1. Who to Cardiovert and who not to
2. Active vs Wait and See + can we predict who will cardiovert?
3. Drugs vs Electricity
4. Pads Placement
5. What Energy To Use?
6. Should We anticoagulate?
7. Some Scores that might change your practice

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References

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2. Cotter P E et al. Incidence of Atrial Fibrillation detected by implantable loop recorders in unexplained stroke. Neurology 2013;80: 1546-50
3. Healey J S etal. Subclinical Atrial Fibrillation and the risk of Stroke. NEJM 2012;266:120-129

4. Ip J et al. Multicenter randomised study of anticoagulation guided remote rhythm monitoring in patients with implantable cardiaoverter-defibrillator and CRT-D devices: Rationale, design and clinical characteristics of the initially enrolled cohort. Am Heart J 2009;188:364-70.

5. Boriani G et al. Device-detected atrial fibrillation and risk for stroke: an analysis of >10,000 patients from the SOS AF project (Stroke prevention Strategies based on Atrial Fibrillation information from implanted devices. Europ Heart J 2014;35:508-516.
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8. Daoud EG et al. Temporal relationship of atrial tachyarrhythmias, cardiovascular events and systemic emboli based on stored device data: a subgroup analysis of trends. Heart Rhythm 2011; 8:1416-23

9. Palomaki A et al. Strokes after cardioversion of atrial fibrillation- The FibStroke Study. Int J Card 2016;203:269-273

10. Johansson AK, et al. Is one month treatment with dabigatran before cardioversion of atrial fibrillation sufficient to prevent thromboembolism? Europace. 2015;17:1514-1517.

11.  Hendrika A van den Ham et al. Major bleeding in users of direct oral anticoagulants in atrial fibrillation: A pooled analysis of results from multiple population-based cohort studies. Pharmacoepidemiol Drug Saf. . 2021 Oct;30(10):1339-1352.

12.  Lopes RD, et al. Rationale and design of the Apixaban for the Reduction of Thrombo-Embolism in Patients With Device-Detected Sub-Clinical Atrial Fibrillation (ARTESiA) trial. Am Heart J. 2017;189:137–145

13. Keith A A. et al. GARFIELD-AF risk score for mortality, stroke, and bleeding within 2 years in patients with atrial fibrillation. Europ Heart Jour - Quality of Care and Clinical Outcomes (2022) 8, 214–227
14. Pluymaekers N et al. Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation. NEJM 2019;380:1499-1508
15. Niederdockl J et al. Predicting Spontaneous Conversion to sinus rhythm in symptomatic atrial fibrillation: The ReSinus score. Eurpo J Int Med. 2021;83:45-53
16. Stiell IG et al. Electrical Versus Pharmacological Cardioversion for Emergency Department Patients with Acute Atrial Fibrillation (RAFF2): A Partial Factorial Randomised Trial. Lancet 2020. PMID: 32007169
17. Schmidt A S. Antero-Lateral Versus Anterior-Posterior Electrode Position for Converting Atrial Fibrillation. Circulation. 2021;144:1995–2003. 
18. Glover B M, et al Biphasic Energy Selection for transthoracic cardioversion of atrial fibrillation. The BEST AF Trial. Heart. 2008 Jul;94(7):884-7