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In patients with atrial fibrillation (AF):

True / False

When taking warfarin, the international normalised ratio (INR) should be maintained between 2 and 3 Correct

Less than 10% of patients will revert spontaneously to sinus rhythm within one week of onset Correct

Amiodarone should be avoided in those congestive cardiac failure Correct

Antiarrhythmic drugs are successful in converting atrial fibrillation (of less than seven days duration) in less than 10% of patients Correct

Flecainide should be avoided in those with ischaemic heart disease Correct

Explanation

Up to 60% of patients revert to sinus rhythm within a few days of developing AF. Provided pharmacological conversion is attempted within seven days, successful restoration of sinus rhythm can occur in up to 90% of patients.

Flecainide should be avoided in patients with ischaemic heart disease and any evidence of myocardial dysfunction.

Risk of thrombosis can be stratified using the CHA2DS2-VASc score . This system scores points up to a maximum of 9, for each of the following risk factors:

Age <65 0 points

65-74 1 point

=75 2 points

Gender Male 0 points

Female 1 point

Congestive heart failure 1 point

Hypertension 1 point

Stroke, TIA, or thromboembolism 2 points

Vascular disease 1 point

Diabetes mellitus 1 point

A score of 0 indicates low risk, a score of 1 indicates low-to-medium risk and a score of 2 or more indicates moderate-to-high risk. NICE guidelines on atrial fibrillation recommend that people with a CHA2DS2-VASc score of 2 or more should be offered anticoagulation with apixaban, dabigatran etexilate, rivaroxaban, or a vitamin K antagonist.

It should be noted that aspirin monotherapy should not be offered solely for stroke prevention in these people.

Amiodarone should be used in those with evidence of myocardial dysfunction.

Reference:

NICE. Atrial fibrillation: the management of atrial fibrillation (CG180).

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