Wed3November0903PM 9

In adult patients with paroxysmal atrial fibrillation (AF):

True / False

Anticoagulation is not required Incorrect answer selected

Sotalol is contraindicated in those with coronary artery disease Correct

Long term drug prophylaxis is not necessary for healthy patients who only have very infrequent episodes of AF Correct

Episodes of AF are commonly triggered by binge drinking Correct

Amiodarone is first line treatment Correct

Explanation

Amiodarone is third line treatment in paroxysmal AF. According to NICE guidelines the first line treatment is a standard beta blocker. In the event of this failing, sotalol is the drug of choice.

A "pill-in-the-pocket" approach is now believed to be safe in healthy patients who have infrequent episodes of AF.

Patients with paroxysmal AF should undergo risk assessment for thromboembolic disease. Those at "high" risk will benefit from anticoagulation.

Risk is calculated using the CHAD2SVASc score. The risk factors are:

C - Congestive heart failure history (+1)

H - Hypertension history (+1)

A - Age <65 (0), 65-74 (+1), >75 (+2)

D - Diabetes mellitus (+1)

S - Stroke previous thromboembolism (+2)

Sex-Male (0), female (+1)

Vascular disease history (+1)

A score of 0 is considered to be low risk for thromboembolic events, score of 1 intermediate risk (0.6% rate at 1 year), and greater than 1 high risk (3% rate at 1 year).

Binge drinking is a common trigger of paroxysmal AF.

Reference:

NICE. Atrial fibrillation: management (CG180).

Answer Statistics

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Average score: 77.32%

Times answered: 269