From Wikidoc - Reading time: 2 min
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Implantable Cardiac Defibrillator[edit | edit source]
- Should not be implanted within 40 days of STEMI
- A patient should wear a defibrillator vest while awaiting AICD implantation
- Amiodarone improves CV survival but not all cause survival in patients with an LVEF of <40%
- If someone with an ICD has refractory arrhythmias then radiofrequency ablation of the VT focus can be attempted
- Sotalol also reduces the frequency of shocks in patients with CAD
Anticoagulation based on the CHADS2 score[edit | edit source]
The following treatment strategies are recommended in the table below entitled Anticoagulation based on the CHADS2 score:[1][2]
Score
|
Risk
|
Anticoagulation Therapy
|
Considerations
|
0
|
Low
|
Aspirin
|
Aspirin daily
|
1
|
Moderate
|
Aspirin or Warfarin
|
Aspirin daily or INR to 2.0-3.0, depending on factors such as patient preference
|
2 or greater
|
Moderate or High
|
Warfarin
|
INR to 2.0-3.0, unless contraindicated (e.g. clinically significant GI bleeding, inability to obtain regular INR screening)
|
Rate Control vs Rhythm Control[edit | edit source]
- Rhythm control offers no benefit over rate control in survival
- Rate control is very important in preventing the tachycardia cardiomyopathy syndrome. Patients who are hyperthyroid should be treated with Lopressor until they are euthyroid.
- Dronedarone reduces hospitalization for atrial fibrillation by about a quarter
- A complication of radio frequency ablation is left atrial tachycardia or flutter. This complication may itself require treatment.
- Anticoagulation should be continued after radiofrequency ablation.
- In patients who have a rapid ventricular response rate in atrial fibrillation and who develop a tachycardia induced cardiomyopathy, AV junctional ablation can be undertaken with permanent pacemaker placement.
- QT prolongation can be treated with metoprolol
These patients are at risk of rapid conduction of atrial fibrillation and VT / VF
- EP study and RF ablation of the bypass tract
- Do not use drugs that might block AV node and send conduction down accessory pathway
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