Thank you Dr. Feng for an excellent presentation on the management of atrial fibrillation in the setting of acute de-compensated heart failure

Teaching Points

• Important components of management: hemodynamic stability, rate control, anti-coagulation
• Rate control agents: beta blockers, calcium channel blockers (not preferred in HF), digoxin and amiodarone (also an anti-arrhythmic)
• Antiarrhythmics for afib are Class IC or III
  • IC: flecainide, propafeonone
  • III: amiodarone, dronedarone, sotalol, dofetilide
• Anti-coagulation: indicated if CHADSVASc ≥ 2 (warfarin or newer agents, ie apixaban or rivaroxaban)

PowerPoint:
Morning Report – 07-08-2016

Further Reading:
A comparison of rate control and rhythm control in patients with atrial fibrillation (AFFIRM trial)
Lenient versus strict rate control in patients with atrial fibrillation (RACE II trial)
Dabigatran versus warfarin in patients with atrial fibrillation (RE-LY trial)
Rivaroxaban versus warfarin in nonvalvular atrial fibrillation (ROCKET-AF trial)
Apixaban versus Warfarin in Patients with Atrial Fibrillation (ARISTOTLE trial)