Atrial Fibrillation

 

 

Considerations

 

  • ↑ risk perioperative cardiac complications 

  • Etiology:

    • Structural/valvular heart disease

    • Other secondary causes: Alcoholism, electrolyte imbalance, hyperthyroidism, infection, etc

  • Complications of atrial fibrillation:

    • CHF, tachycardia-induced cardiomyopathy

    • Embolic events & stroke risk 

  • Medication management:

    • Rate control & rhythm control (beta blockers, calcium channel blockers, digoxin, amiodarone) 

    • Anticoagulation: Bridge for those with CHADS2≥4 in consultation with hematology

 

 

Optimization/Goals 

 

  • ACLS approach, cardiovert if unstable 

  • Elective cases:

    • if HR < 110, no CHF: proceed with OR, may need ASA depending on CHADS2

    • If CHF or HR > 110: needs optimization in consultation with cardiology, internal medicine, or patient's GP 

  • Fix underlying electrolyte abnormalities 

  • Rate control in sick patients:

    • Amiodarone

    • Digoxin in LV dysfunction: 0.25-0.5mg IV initial dose, follow ECGs

  • Emergency cases: ↑ risk if HR > 110 or CHF

  • Consider cardiology consult/monitored bed 

  • Octaplex or FFP or Vit K for emergent INR reversal 

 

 

CHADS2 Scoring System 

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