WorksheetsACES Episode 7
Total questions: 14
Worksheet time: 11mins
A 50-year-old man was admitted to the CCU with an NSTEMI. A coronary angiogram revealed an 80% lesion in the left anterior descending artery, for which a drug-eluting stent was placed. A transthoracic echo revealed an LVEF of 50% to 55% without significant valvular disease. On auscultation, the patient’s lungs are clear, and there is no S3. Forty-eight hours after percutaneous coronary intervention, the patient develops AF. Which antiarrhythmic medication would be contraindicated as a rhythm-control agent?
Amiodarone
Dofetilide
Dronedarone
Propafenone
Sotalol
You decide to start a 50-year-old man on an antiarrhythmic medication for his AF. Which one of the following statements is INCORRECT?
Class Ic drugs should be combined with a beta-blocker or calcium channel blocker to decrease the risk of atrial flutter with a 1:1 ventricular response
Monitoring the QRS duration and the PR interval is important during class Ic therapy
Sotalol prolongs the ventricular refractoriness and the QT interval
Efforts to avoid hypokalemia and hypomagnesemia are important in patients receiving antiarrhythmic drugs
Class III drugs should be combined with a beta-blocker or calcium channel blocker to decrease the risk of QT prolongation
Which of the following is not a reasonable oral anticoagulation strategy surrounding cardioversion?
Oral warfarin with a therapeutic INR for 3 to 4 weeks before cardioversion, followed by continued warfarin therapy for a minimum of 4 weeks
Oral anticoagulation is unnecessary if the transesophageal echo is negative for intracardiac clot, and the patient is cardioverted with ibutilide
NOAC for 3 weeks before cardioversion followed by a NOAC for a minimum of 4 weeks
In patients without high risk factors for stroke, anticoagulation can be discontinued approximately 4 weeks after cardioversion
Transesophageal echocardiography (TEE) and intravenous heparin immediately before cardioversion followed by oral warfarin for a minimum of 4 weeks
You decide to start your patient on dronedarone after electrical cardioversion. Which of the following statements is INCORRECT?
Dronedarone is a noniodinated benzofuran derivative of amiodarone
Dronedarone blocks multiple channels, including sodium, potassium, and calcium
Dronedarone is indicated in patients with permanent AF
Dronedarone has noncompetitive antiadrenergic effects
Dronedarone is contraindicated in patients with class II to IV heart failure
Your patient, an 84-year-old woman with a normal LV ejection fraction and dual-chamber pacemaker, continues to have significant palpitations from her AF, despite drug therapy. You decide to refer her for an AV node ablation. Which of the following statements is INCORRECT?
Rhythm control with antiarrhythmic medications is more successful after AV node ablation
AV node ablation does not change the long-term need for anticoagulation
Patients may become pacemaker dependent after AV node ablation as a result of an inadequate escape rhythm
Right ventricular pacing produces an abnormal LV contraction sequence, and acute worsening of hemodynamics has been observed in some patients
The development of right ventricular pacing-induced cardiomyopathy can occur
You are having difficulty controlling the ventricular response rate of an 88-year-old woman with permanent atrial fibrillation (AF). Despite high doses of a beta-blocker and a calcium channel blocker, her ventricular rate persists at 110 to 130 bpm at rest. She underwent implantation of a dual-chamber pacemaker several years earlier for tachy-brady syndrome. Which of the followingstatements concerning atrioventricular node (AVN) ablation for this patient is correct?
Post-AVN ablation, she may discontinue oral anticoagulation
Post-AVN ablation, her risk of sudden cardiac death from polymorphic VT is high
Post-AVN ablation, she will no longer be in AF
Post-AVN ablation, an appropriate pacemaker setting is VVI 60 bpm
If she has poor left ventricular function before the procedure, her left ventricular function will definitely improve with AVN ablation
A 34-year-old teacher is referred for consultation because of intermittent palpitations and found to have paroxysmal atrial fibrillation (AF) on ambulatory electrocardiography. His pertinent co-morbid conditions include mild obesity, controlled hypertension, and untreated obstructive sleep apnea. Ethanol and caffeine consumptions are minimal. Echocardiography demonstrates normal left ventricular size and function and mild left atrial enlargement. Exercise treadmill testing reveals no evidence of ischemia. Despite initiation of metoprolol and flecainide, symptomatic AF persists and the patient is referred for catheter ablation. Which of the following statements about ablation for AF is correct?
A trial of antiarrhythmic drug therapy is mandatory before performing AF ablation
The efficacy of catheter ablation for paroxysmal AF is higher than for persistent AF
A successful procedure requires focal ablation of premature atrial beats originating deep within the pulmonary veins
Ablation in the posterior left atrium is associated with a risk of atrial-tracheal fistula
Catheter ablation eliminates the need for chronic anticoagulation in subsequently asymptomatic individuals
A 53-year-old man with symptomatic atrial fibrillation presents for elective outpatient cardioversion. For the past 3 months he has been taking appropriately dosed apixaban as an anticoagulant, and diltiazem for rate control. Which of the following statements about external electrical cardioversion is correct?
Administration of intravenous ibutilide before electrical cardioversion facilitates successful conversion of atrial fibrillation to normal sinus rhythm
Electrical cardioversion is most effective at terminating tachycardias that arise from enhanced automaticity
Repeated shocks at the same energy level increase chest wall impedance
Apixaban can be safely discontinued 7 days after successful cardioversion if sinus rhythm is achieved
A 62-year-old woman attends clinic following an ED attendance 6 weeks previously with a one-week history of palpitations. She was diagnosed with AF at the time and commenced on apixaban and a beta-blocker. Her echocardiogram showed no significant abnormalities and her ECG in clinic today confirms atrial fibrillation with a ventricular rate of 70 bpm. She continues to get occasional palpitations and would like to be considered for cardioversion. What do you advise?
She needs to be warfarinized for at least 48 hours pre-cardioversion
Anticoagulation should be continued after successful cardioversion for at least 4 weeks
If a TOE rules out atrial thrombus, no anticoagulation is required post-procedure
Anticoagulation is not required prior to chemical cardioversion
Anticoagulation is not required prior to cardioversion as her CHA2DS2-VASc score is zero
A 72-year-old man with symptomatic persistent atrial fibrillation is admitted for pulmonary vein isolation. Which one of the following statements is most likely to be true?
The risk of stroke is around 5%
The chance of successful ablation of the arrhythmia is around 90% at 1 year
The chance of successful ablation is higher for persistent AF than for paroxysmal AF
The risk of cardiac tamponade is around 5%
The risk of pulmonary vein stenosis is around 5%
Corner stone AF ablation:
(choose all correct answer)
Left antrum ablation
CTI ablation
Right antrum ablation
Roof line
The correct statement for AF:
(choose all correct answer)
AF is a progressive disease
AF is not progressive disease but causing progressive complication rate
Time in sinus rhythm is associated with improved mortality and morbidity
The most optimal therapy to maintain SR is AADs
The correct statement for AF ablation:
(choose all correct answer)
Effective to prevent AF recurrence
Effective to increase quality of life
Effective to reduce AF related symptom
Effective to reduce stroke event
General Consideration for AF ablation are:
(choose all correct answer)
Major risk factors of recurrences
Discuss with patient
Complication risks
Discuss with family
Experienced center
