DRUG ROUTE DOSE C/I or RECAUTIONS or COMMENTS
AMIODARONE Oral 200 mg TDS X 4 wks
then 200 mg OD
Most effective, stop if QTc is >500 ms, ECG
repeat after 4 weeks
FLECAINIDE Oral 100 – 200 mg BD C/I in IHD and HFrEf, discontinue if QRS
widen >25% and in pt. with LBBB, ECG after
PROPAFENONE Oral 150 – 300 mg TDS C/I in CKD, CLD. Discontinue if QRS widen
>25% and in pt. with LBBB, ECG after 2 wks
DRONADARONE Oral 400 mg BD Less effective than amiodarone. Not be used
in NYHA class III or IV or unstable HF.
Discontinue if QTc > 500 ms. ECG after 4
SOTALOL Oral 80 – 160 mg BD Not be used in HFrEF, significant LVH,
prolonged QT, asthma, hypokalaemia, CKD.
ECG after 1 day and 2 weeks
DISOPYRAMIDE Oral 100 – 400 mg BD or
Rarely used as it increases mortality. May be
useful in vagal AF
III. CARDIOVASCULAR RISK FACTOR AND
• Lifestyle intervention
- Obesity and weight loss
- Alcohol and caffeine
- Physical activity
• Specific cardiovascular risk factor / comorbidities
- Heart failure
- Coronary artery disease
- Sleep apnea
BETTER SYMPTOM CONTROL
CARDIOVASCULAR RISK FACTORS AND CONCOMITANT DISEASE
GARFIELD – AF
Intermountain risk score
0-2 Low Bleeding risk
VKA are not referred due to req. of regular INR monitoring and dose adjus. BUT the are cheap. Also, the meta analysis showed OAC Asians mein more effective and safe
In AF patients with high bleeding risk due to uncontrolled HTN, Low platelet, hemophilia, severe hepatic / renal dysfunction.
Previously rhythm control was for – young, AF < 6 months, without structural heart disease, 1st episode. But now improve QoL and reduce AF related symptoms.
Tell about CABANA TRIAL. Also tell about Cox Maze procedure and how difficult it is and results are not consistent in trials. aMAZE trial resuts.
Six symptoms, including palpitations, fatigue, dizziness, dyspnoea, chest pain, and anxiety during AF, are evaluated with regard to how it affects the patient’s daily activity, ranging from none to symptom frequency or severity that leads to a discontinuation of daily activities.
Data lacking as the patients were excluded.
Stable vascular disease – No new vascular event in past 12 months. As beta blocker may exacerbate PAD.
RFA should not be done when active hyperthyroid
And this less is despite sufficient evidence available