What the 2023 AFib Guidelines Tell Us About Rhythm and Rate Control in Special Populations On Demand)-Rhythm and Rate Control in Special Populations

Video Transcription

Video Summary

In this comprehensive HRS webinar, Dr. Fred Kusumoto moderates a session focusing on the 2023 AF (Atrial Fibrillation) Guidelines, emphasizing rhythm and rate control in special populations. The session begins with an introduction to the recent guidelines by Janice Chute, who outlines the management of AF in various scenarios: pregnancy, cardio-oncology, cardiac surgery, and acute medical illness.<br /><br />For pregnancy, electrical cardioversion is considered safe, whereas pharmacological cardioversion with agents like ibutilide is limited by potential risks. Rhythm control during pregnancy often involves safe-use antiarrhythmics like flecainide. Rate control may include Digoxin and beta-blockers, while calcium-channel blockers are generally avoided due to adverse fetal impacts.<br /><br />Cardio-oncology management requires multidisciplinary communication to avoid drug-drug interactions impacting metabolism pathways and addressing associated treatment risks like QT prolongation and thromboembolism.<br /><br />In cardiac surgery, the guidelines recommend beta-blockers and limited use of amiodarone pre-surgery for high-risk patients, and posterior left pericardiotomy during surgery to prevent postoperative AF. Postoperative management involves direct current cardioversion for hemodynamically unstable patients and using beta-blockers for rate control.<br /><br />Janice underscores that previously considered transient AF triggered by non-cardiac illnesses carries a substantial recurrence risk, necessitating outpatient follow-up and longer-term rhythm surveillance. Continuous rhythm monitoring should be more intensive for high-risk patients.<br /><br />Subsequently, Sunil Krishnan elaborates on AF management in heart failure patients. For decompensated heart failure, amiodarone is recommended, whereas non-dihydropyridine calcium-channel blockers are contraindicated. He also advocates for early rhythm control in AF patients to prevent adverse remodeling in the heart.<br /><br />Lastly, the Q&A session, managed by Andrew Kranz, highlights real-world case applications of the discussed guidelines, emphasizing the need for patient-centered approaches and the multidisciplinary management of AF, considering individual patient preferences and comorbidities. The session concludes with reiteration of the importance of comprehensive care systems.<br /><br />Overall, the webinar provides detailed, guideline-based approaches for managing AF in special populations, emphasizing individualized care and the importance of multidisciplinary coordination.

Keywords

Atrial Fibrillation

2023 Guidelines

Rhythm Control

Rate Control

Pregnancy

Cardio-oncology

Cardiac Surgery

Acute Medical Illness

Heart Failure

Multidisciplinary Management

Antiarrhythmics

Beta-blockers

Patient-centered Care