Atrial Fibrillation
Considerations
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↑ risk perioperative cardiac complications
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Etiology:
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Structural/valvular heart disease
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Other secondary causes: Alcoholism, electrolyte imbalance, hyperthyroidism, infection, etc
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Complications of atrial fibrillation:
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CHF, tachycardia-induced cardiomyopathy
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Embolic events & stroke risk
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Medication management:
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Rate control & rhythm control (beta blockers, calcium channel blockers, digoxin, amiodarone)
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Anticoagulation: Bridge for those with CHADS2≥4 in consultation with hematology
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Optimization/Goals
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ACLS approach, cardiovert if unstable
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Elective cases:
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if HR < 110, no CHF: proceed with OR, may need ASA depending on CHADS2
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If CHF or HR > 110: needs optimization in consultation with cardiology, internal medicine, or patient's GP
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Fix underlying electrolyte abnormalities
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Rate control in sick patients:
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Amiodarone
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Digoxin in LV dysfunction: 0.25-0.5mg IV initial dose, follow ECGs
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Emergency cases: ↑ risk if HR > 110 or CHF
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Consider cardiology consult/monitored bed
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Octaplex or FFP or Vit K for emergent INR reversal
CHADS2 Scoring System
