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/* ACCF/AHA/HRS 2011 Guidelines- Pregnancy (DO NOT EDIT) Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the America...
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==ACCF/AHA/HRS 2011 Guidelines- Pregnancy (DO NOT EDIT) <ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.] ''Circulation'' 114 (7):e257-354. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref><ref name="pmid21382897">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21382897 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.] ''Circulation'' 123 (10):e269-367. [http://dx.doi.org/10.1161/CIR.0b013e318214876d DOI:10.1161/CIR.0b013e318214876d] PMID: [http://pubmed.gov/21382897 21382897]</ref>==
==ACCF/AHA/HRS 2011 Guidelines- Pregnancy (DO NOT EDIT) <ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.] ''Circulation'' 114 (7):e257-354. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref><ref name="pmid21382897">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21382897 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.] ''Circulation'' 123 (10):e269-367. [http://dx.doi.org/10.1161/CIR.0b013e318214876d DOI:10.1161/CIR.0b013e318214876d] PMID: [http://pubmed.gov/21382897 21382897]</ref>==
{{cquote|
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]===
'''1.''' [[Digoxin]], a [[beta blocker]], or a non [[dihydropyridine]] [[calcium channel antagonist]] is recommended to control the rate of ventricular response in [[pregnant]] patients with [[AF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


'''2.''' [[Direct-current cardioversion]] is recommended in pregnant patients who become hemodynamically unstable due to [[AF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[Digoxin]], a [[beta blocker]], or a non [[dihydropyridine]] [[calcium channel antagonist]] is recommended to control the rate of ventricular response in [[pregnant]] patients with [[AF]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]]) <nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' [[Direct-current cardioversion]] is recommended in pregnant patients who become hemodynamically unstable due to [[AF]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]]) <nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Protection against [[thromboembolism]] is recommended throughout [[pregnancy]] for all patients with [[AF]] (except those with lone [[AF]] and/or low thromboembolic risk). Therapy ([[anticoagulant]] or [[aspirin]]) should be chosen according to the stage of [[pregnancy]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]]) <nowiki>"</nowiki>
|}


'''3.''' Protection against [[thromboembolism]] is recommended throughout [[pregnancy]] for all patients with [[AF]] (except those with lone [[AF]] and/or low thromboembolic risk). Therapy ([[anticoagulant]] or [[aspirin]]) should be chosen according to the stage of [[pregnancy]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
{|class="wikitable"
 
|-
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]===
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
'''1.''' Administration of [[heparin]] may be considered during the first trimester and last month of [[pregnancy]] for patients with [[AF]] and risk factors for [[thromboembolism]]. [[Unfractionated heparin]] may be administered either by continuous intravenous infusion in a dose sufficient to prolong the [[activated partial thromboplastin time]] to 1.5 to 2 times the control value or by intermittent subcutaneous injection in a dose of 10 000 to 20 000 units every 12 h, adjusted to prolong the mid-interval (6 h after injection) [[activated partial thromboplastin time]] to 1.5 times control. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
|-
 
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' A combination of digoxin and either a beta blocker, diltiazem, or verapamil is reasonable to control the heart rate both at rest and during exercise in patients with AF. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
'''2.''' Despite the limited data available, subcutaneous administration of [[low molecular weight heparin]] may be considered during the first trimester and last month of [[pregnancy]] for patients with [[AF]] and risk factors for [[thromboembolism]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
|-
 
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' It is reasonable to use ablation of the arterioventricular (AV) node or accessory pathway to control heart rate when pharmacological therapy is insufficient or associated with side effects.([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
'''3.''' Administration of an oral [[anticoagulant]] may be considered during the second trimester for [[pregnant]] patients with [[AF]] at high thromboembolic risk. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
|-
 
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' Administration of an oral [[anticoagulant]] may be considered during the second trimester for [[pregnant]] patients with [[AF]] at high thromboembolic risk. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]]) <nowiki>"</nowiki>
'''4.''' Administration of [[quinidine]] or [[procainamide]] may be considered to achieve pharmacological [[cardioversion]] in hemodynamically stable patients who develop [[AF]] during pregnancy. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' Administration of [[quinidine]] or [[procainamide]] may be considered to achieve pharmacological [[cardioversion]] in hemodynamically stable patients who develop [[AF]] during pregnancy. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]]) <nowiki>"</nowiki>
|}


==Vote on and Suggest Revisions to the Current Guidelines==
==Vote on and Suggest Revisions to the Current Guidelines==

Revision as of 16:45, 4 October 2012

Conduction
Sinus rhythm
Atrial fibrillation
'
ICD-10 I48
ICD-9 427.31
DiseasesDB 1065
MedlinePlus 000184

Atrial Fibrillation Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S.

Overview

The presence of atrial fibrillation is rare in pregnancy and has an identifiable underlying etiology such as mitral stenosis,[1] congenital heart disease,[2] or hyperthyroidism.[3] Digoxin, beta blocker or non-dihydropyridine CCB may be used to control the ventricular rate.[4][5][6] Quinidine has been shown to be safe in pregnancy and remains the drug of choice for pharmacological cardioversion of AF in pregnancy.[7] In cases of hemodynamic instability, direct-current cardioversion may be performed without fetal damage.[8]

ACCF/AHA/HRS 2011 Guidelines- Pregnancy (DO NOT EDIT) [8][9]

Class I
"1. Digoxin, a beta blocker, or a non dihydropyridine calcium channel antagonist is recommended to control the rate of ventricular response in pregnant patients with AF. (Level of Evidence: C) "
"2. Direct-current cardioversion is recommended in pregnant patients who become hemodynamically unstable due to AF. (Level of Evidence: C) "
"3. Protection against thromboembolism is recommended throughout pregnancy for all patients with AF (except those with lone AF and/or low thromboembolic risk). Therapy (anticoagulant or aspirin) should be chosen according to the stage of pregnancy. (Level of Evidence: C) "
Class IIb
"1. A combination of digoxin and either a beta blocker, diltiazem, or verapamil is reasonable to control the heart rate both at rest and during exercise in patients with AF. (Level of Evidence: B) "
"2. It is reasonable to use ablation of the arterioventricular (AV) node or accessory pathway to control heart rate when pharmacological therapy is insufficient or associated with side effects.(Level of Evidence: B) "
"3. Administration of an oral anticoagulant may be considered during the second trimester for pregnant patients with AF at high thromboembolic risk. (Level of Evidence: C) "
"4. Administration of quinidine or procainamide may be considered to achieve pharmacological cardioversion in hemodynamically stable patients who develop AF during pregnancy. (Level of Evidence: C) "

Vote on and Suggest Revisions to the Current Guidelines

Guideline Resources

References

  1. ↑ Bryg RJ, Gordon PR, Kudesia VS, Bhatia RK (1989) Effect of pregnancy on pressure gradient in mitral stenosis. Am J Cardiol 63 (5):384-6. PMID: 2913749
  2. ↑ Whittemore R, Hobbins JC, Engle MA (1982) Pregnancy and its outcome in women with and without surgical treatment of congenital heart disease. Am J Cardiol 50 (3):641-51. PMID: 7113941
  3. ↑ Forfar JC, Miller HC, Toft AD (1979) Occult thyrotoxicosis: a correctable cause of "idiopathic" atrial fibrillation. Am J Cardiol 44 (1):9-12. PMID: 110126
  4. ↑ Page RL (1995) Treatment of arrhythmias during pregnancy. Am Heart J 130 (4):871-6. PMID: 7572599
  5. ↑ Chow T, Galvin J, McGovern B (1998) Antiarrhythmic drug therapy in pregnancy and lactation. Am J Cardiol 82 (4A):58I-62I. PMID: 9737655
  6. ↑ O'Nunain S, Garratt CJ, Linker NJ, Gill J, Ward DE, Camm AJ (1991) A comparison of intravenous propafenone and flecainide in the treatment of tachycardias associated with the Wolff-Parkinson-White syndrome. Pacing Clin Electrophysiol 14 (11 Pt 2):2028-34. PMID: 1721219
  7. ↑ Vaughan Williams EM (1984) A classification of antiarrhythmic actions reassessed after a decade of new drugs. J Clin Pharmacol 24 (4):129-47. PMID: 6144698
  8. ↑ 8.0 8.1 8.2 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114 (7):e257-354. DOI:10.1161/CIRCULATIONAHA.106.177292 PMID: 16908781
  9. ↑ 9.0 9.1 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 123 (10):e269-367. DOI:10.1161/CIR.0b013e318214876d PMID: 21382897
  10. ↑ Estes NA, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS et al. (2008) ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation): developed in collaboration with the Heart Rhythm Society. Circulation 117 (8):1101-20. DOI:10.1161/CIRCULATIONAHA.107.187192 PMID: 18283199

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