Atrial Fibrillation

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Source: Institute for Clinical Systems Improvement (ICSI). Atrial fibrillation. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2007 Feb. 64 p. Atrial Fibrillation A = Annotation Five key management steps for A Fib: SALT-E Patient presentation: signs or physical findings suggestive with A Fib / A Flutter or incidental ECG finding. A S - stabilize. A - assess. L - label for stratification of treatment options. T - treatment options. E - education. ECG confirms A Fib and / or A Flutter? A Out of guideline *Look for other causes Is pre-excitation/WPW present? Stabilize patient: *Assess for potentially reversible causes/comorbidities. *Electrophysiology consult. Stabilize patient: *Hemodynamic stabilization. *Acute rate control. A Assess for: *Risk factors for thromboembolism. *Risk factors for bleeding. *Hypertension. *Coronary ischemia. *Heart failure. *Obstructive sleep apnea. *Other potentially reversible causes and comorbidities. *Initiation of anticoagulation. A Initiate treatment based on Label First detected episode duration known greater than or equal to 48 hrs or duration unknown. A Recurrent A Fib *Paroxysmal. *Persistent. *Permanent. Recurrent A Flutter Assess patient for chronic anticoagulation. A Assess patient for surgical options concurrent with cardiac surgery Treatment: Electrophysiology consult Treatment options: A. Conventional anticoagulation and cardioversion. B. Chronic rate control and chronic anticoagulation. Note: insufficient evidence to recommend TEE-guided anticoagulation Assess patient for chronic anticoagulation Patient education Assess patient for rate control agents. A Age less than or equal to 65? Consultation for treatment options: *Intermittent cardioversion. *Antiarrythmics. *Electrophysiology consult. -Cardiac pacing. -Catheter-based ablative therapies. -Pulmonary vein isolation techniques. -Surgical maze procedure. A Inadequate rate control? A Inadequate symptom control? A Other concerns? A Monitor for recurrence and patient education *Pulse monitoring. *Adjuctive monitoring. *Aggressive management of patient comorbidities (hypertension). A All copyrights are reserved by the Institute for Clinical Systems Improvement, Inc.