Rapid Clinical Updates: Challenging Inpatient Scenarios in Atrial Fibrillation-Presentation

Video Transcription

Video Summary

This rapid clinical update session focused on managing challenging inpatient scenarios of atrial fibrillation (AF), featuring experts Dr. Noble Malik and Dr. Jonathan Halpern. Key points included the importance of confirming AF via electrocardiogram and stabilizing hemodynamically unstable patients with immediate cardioversion and concurrent anticoagulation to prevent thromboembolism. For stable patients, triggers like sepsis, surgery, or metabolic disturbances should be identified and treated. Rate control, typically with beta blockers or calcium channel blockers, is the first-line approach; digoxin and amiodarone have specific roles but require careful use. Rhythm control is preferred for symptomatic patients or those with recent-onset AF to reduce progression and complications. Anticoagulation decisions rely on CHA2DS2-VASc scores, favoring direct oral anticoagulants unless contraindicated. In acute illness like sepsis, immediate anticoagulation may increase bleeding risk without reducing stroke, so postponement until stabilization is advised. Recurrence risk after acute AF is high, thus follow-up and risk factor optimization (e.g., managing hypertension, obesity, sleep apnea) are crucial. Shared decision-making guides anticoagulation in complex cases, especially with limited life expectancy or bleeding risks. Ambulatory monitoring may aid risk assessment but requires logistical consideration. Overall, the session emphasized individualized, evidence-based inpatient and discharge management strategies for AF to improve outcomes.

Keywords

atrial fibrillation

electrocardiogram

cardioversion

anticoagulation

rate control

rhythm control

CHA2DS2-VASc score

sepsis

shared decision-making