Cardiology overview electrophysiology

Cardiology Overview

Home

Acute Coronary Syndromes

Antiplatelets and antithrombins

Cardiomyopathy

Congenital heart disease

Electrophysiology

Heart failure

Hypertension

Imaging

Invasive cardiology

Pericardial disease

Peripheral arterial disease

Pharmacology

Pregnancy

Preoperative evaluation

Prevention

Pulmonary hypertension

Stable angina

Valvular heart disease

Venous thromboembolism

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

## Contents

* 1 STEMI and Arrhythmias
* 1.1 Implantable Cardiac Defibrillator
* 2 Atrial Fibrillation
* 2.1 Anticoagulation
* 3 Anticoagulation based on the CHADS2 score
* 3.1 Rate Control vs Rhythm Control
* 3.2 Radiofrequency Ablation
* 4 QT prolongation
* 5 WPW
* 5.1 Complications
* 5.2 Treatment
* 6 References

## STEMI and Arrhythmias

[edit | edit source]

### 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

## Atrial Fibrillation

[edit | edit source]

### Anticoagulation

[edit | edit source]

* Patients with a CHADS2 score of two or higher should be anticoagulated with warfarin. Some clinicians believe that any patient with congestive heart failure should also be anticoagulated with warfarin.

## 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

### Radiofrequency Ablation

[edit | edit source]

* 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

[edit | edit source]

* QT prolongation can be treated with metoprolol

## WPW

[edit | edit source]

### Complications

[edit | edit source]

These patients are at risk of rapid conduction of atrial fibrillation and VT / VF

### Treatment

[edit | edit source]

* EP study and RF ablation of the bypass tract
* Do not use drugs that might block AV node and send conduction down accessory pathway

## References

[edit | edit source]

1. ↑ Invalid `<ref>` tag; no text was provided for refs named `pmid15477396`
2. ↑ Invalid `<ref>` tag; no text was provided for refs named `Gage2001`

Template:WS Template:WH