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 Rhythem control for AFIB  



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Author7 Posts
  #1

As far as i undestand that AFib is managed as following :
- If Unstable => cardioversion
- If Stable => Rate control + anti coagulation
right ?
so what about rhythem control ? How would you answer ?
- Amiodarone ?
- elective cardioversion after a 3-4 week of anti coagulation ?





  #2

warfarin only if >48 hrs

for chronic AF dont attempt rhytm control as rate control+ warfarin is equal to or superior to rhytm control


  #3

Fred33 wrote:
What I've understood:

Asymptomatic: treat to have pulse under 100 and anticoagulate

Symptomatic: more than 48 hours, anticoagulate and THEN, several weeks later, rhythm control. Less than 48h it's safe to anticoagulate and control rhythm right away because there is no time for a clot to have formed inside the heart.

You can control rhythm either mechanically (electrically) or pharmacologically. There are pros and cons for each, but both seem, for USMLE purposes, equally acceptable.


So in Afib,
- You anti-coagulate anyway, but " when " is the real question ? what is the alternative if there is a contraindication for anticoagulation ?




Edited by Cordoba on Nov 19, 2009 - 1:40 PM

  #4

In pt. with asymptomatic A. Fib control rate,if >48 hrs anticoagulate with warfarin...anticoagulation with warfarin is always superior then rhythm control but that doesnt mean rhythm control is not important...
In pt. with symptomatic A. Fib , < 48 hrs, cardioversion...
If > 48 hrs and stable rate control,anticoagulation for several weeks and then cardioversion thus reducing the risk of thromboebolism



  #5

Cordoba wrote:
Fred33 wrote:
What I've understood:

Asymptomatic: treat to have pulse under 100 and anticoagulate

Symptomatic: more than 48 hours, anticoagulate and THEN, several weeks later, rhythm control. Less than 48h it's safe to anticoagulate and control rhythm right away because there is no time for a clot to have formed inside the heart.

You can control rhythm either mechanically (electrically) or pharmacologically. There are pros and cons for each, but both seem, for USMLE purposes, equally acceptable.


So in Afib, - You anti-coagulate anyway, but " when " is the real question ? what is the alternative if there is a contraindication for anticoagulation ?





no u dont anticoagulate anyway........



dont anticoagulate if :

1-this is lone AF



2-there is contra to anticoagulation

some of these contras are temporary like recent surgery so wait........if permenant like hx of intracranial bleeding 1 million years ago never anticoagulate.


  #6

i think when symptomatic & AF is <48 hrs we should go for cardioversion, and then anticoagulate the pt.
when cardoba or fred33 say:' Less than 48h it's safe to anticoagulate and control rhythm right away because there is no time for a clot to have formed inside the heart' --- IT IS STILL UNCLEAR WHETHER TO ANTICOAGULATE FIRST AND THEN CARDIOVERT.

I WANT U TO TAKE A LOOK AT KAPLAN IM NOTES REGARDING THIS, ON PAGE 151 THERE IS FLOW CHART FOR MANAGEMENT OF AF, TAKE A LOOK AT MANAGEMENT OF AF IF > OR < 48HRS. ITS CONTRADICTING WHAT WE ARE SAYING!!!!!


  #7

i wouldnot cardiovert a stable patient if he has AF less than 48 hrs......would just control rate by either bblockers ca blockers or digoxin





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