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ClearRounds Health · Cardiology · Quick Reference
Atrial Fibrillation / Atrial Flutter
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Arrhythmias & DevicesAllIn progressOne-page PDF
Rate vs rhythm control, anticoagulation, CHA₂DS₂-VASc, HAS-BLED, cardioversion, ablation referral, and common clinic scenarios.
Covers both atrial fibrillation and atrial flutter.
Last reviewed
Pending initial clinical review
Sources / guidelines to verify
- 2023 ACC/AHA/ACCP/HRS Atrial Fibrillation Guideline
- Local anticoagulation & cardioversion protocols
Disclaimer: Educational reference only. Not a substitute for clinician judgment, local protocols, or current guideline review.
One-page reference
Draft content pending the site owner’s clinical review. Verify against the sources above and local protocol before clinical use.
1
What it is / why it matters
- Most common sustained arrhythmia; raises stroke and heart-failure risk.
- AF: irregularly irregular, no discrete P waves. Flutter: regular "sawtooth," atrial rate ~300 with frequent 2:1 conduction (ventricular ~150).
2
Key diagnostic clues
- Palpitations, fatigue, dyspnea, lightheadedness — or asymptomatic.
- ECG confirms; ambulatory monitor for paroxysmal symptoms.
- Screen reversible triggers: thyroid disease, sepsis/illness, OSA, alcohol, PE.
3
Initial workup
- ECG, echocardiogram, TSH, CBC, BMP.
- Assess symptom burden, hemodynamics, and stroke risk.
4
Management framework
Stroke prevention
- Score with CHA₂DS₂-VASc; anticoagulate if ≥2 (men) / ≥3 (women), consider at 1 / 2
- DOAC preferred over warfarin (except mechanical valve or moderate–severe mitral stenosis)
- HAS-BLED identifies modifiable bleeding risks — it does not by itself justify withholding anticoagulation
Rate control
- Beta-blocker or non-dihydropyridine CCB (diltiazem/verapamil)
- Avoid diltiazem/verapamil in HFrEF
- Lenient target <110 bpm resting if asymptomatic; stricter if symptomatic
Rhythm control
- Early rhythm control is beneficial in many patients
- Catheter ablation is Class 1 first-line for selected symptomatic paroxysmal AF and in HFrEF
- Cardioversion: only if AF <48 h, or therapeutic anticoagulation ≥3 wk, or TEE-guided — then anticoagulate ≥4 wk after
Risk-factor modification
- Weight loss, BP control, treat OSA, reduce alcohol
5
Red flags / escalate now
- Hemodynamic instability (hypotension, ischemia, pulmonary edema) → urgent synchronized cardioversion.
- AF with WPW / pre-excitation (wide, irregular, very fast): AVOID AV-nodal blockers (adenosine, beta-blockers, CCBs, digoxin) → procainamide or cardioversion.
- Atrial flutter with 1:1 conduction (very rapid, unstable).
6
Follow-up / monitoring
- Renal function for DOAC dosing (or INR if warfarin).
- Reassess rate/rhythm control and symptoms; reinforce anticoagulation adherence.
7
Clinic pearls
- CHA₂DS₂-VASc drives anticoagulation — not symptom severity.
- Falls risk alone rarely justifies stopping anticoagulation.
- Typical flutter responds very well to cavotricuspid isthmus ablation.
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