Regular Narrow Complex Tachycardia
Look for P wave and differentiate lengthy vs brief RP
Pseudo R in V1 and S wave in inferior leads
Very quick RP tachycardia- AVNRT
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Orthodromic vs. Antidromic
Conduction through AV node
Classification of Atrial fibrillation
five sorts
Valvular Afib
-AFib with moderate to excessive rheumatic mitral stenosis or with a mechanical heart valve
(any position); lengthy-term anticoagulation with warfarin is indicated- not NOAC
- tissue prosthesis/MV restore or MAC/degenerative mitral or other non-rheumatic MS is
NOT taken into consideration valvular AF
CHA2DS2-VAsc Score
total of 9- don't forget aortic plaque for vascular disorder
,A.Fib with Hypertrophic Cardiomyopathy
-Anticoagulate (NOAC/Warfarin) irrespective of Chadsvasc score
-Consider cardiac amyloidosis also similar to HCM
When to AC with Afib
Score 0- no NOAC
Score 2 (men) or 3 (girls)- begin NOAC
ESRD or Dialysis with NOAC
Dabigatran, rivaroxaban or edoxaban aren't endorsed
Target of NOAC's
Factor 10a inhibitors- rivaroxaban, apixaban, edoxaban
Direct thrombin inhibitor- Dabigatran
Summary of clinical Trails
NOAC mechanism and excretion
NOAC CrCl or HD
NOAC Drug-Drug interactions
NOAC Rate-Rhythm Drug Interactions
NOAC and HIV/Antigungals
NOAC and Bleeding
AF and PCI
-If triple remedy- clopidogrel > prasugrel
, -if AF and PCI- double remedy with warfarin and clopidogrel/ticogrelor > than triple remedy
-if AF and PCI- double therapy with rivaroxaban/dabigatran and clopidogrel > triple therapy
Watchman LAA closure
-PREVAIL have a look at
-Class IIb
Rate and Rhythm Control Algorithm
Rate Control Contraindications
-Dronederone- NYHA III or IV or latest decompensated HF
Rate control- Target HR
- Lenient rate manage if no HF and no AF symptoms
Pharmacological Cardioversion
Rhythm Control in no SHD
- Ablation is magnificence I simplest in paroxysmal symptomatic AF
Rhythm manage in SHD
- Class IC- contraindicated
AF catheter ablation
-Symptoms are key
-Don’t ablate sufferers who can't be anticoagulated
-Primary indication for ablation need to not be obviating the want for OAC
AF ablation in Heart Failure
CASTLE- AF
HCM and Rhythm manage
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