Atrial fibrillation pregnancy

Revision as of 17:31, 30 October 2011 by Varun Kumar (talk | contribs)
Jump to navigation Jump to search
Conduction
Sinus rhythm
Atrial fibrillation
'
ICD-10 I48
ICD-9 427.31
DiseasesDB 1065
MedlinePlus 000184

Atrial Fibrillation Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Atrial Fibrillation from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Special Groups

Postoperative AF
Acute Myocardial Infarction
Wolff-Parkinson-White Preexcitation Syndrome
Hypertrophic Cardiomyopathy
Hyperthyroidism
Pulmonary Diseases
Pregnancy
ACS and/or PCI or valve intervention
Heart failure

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

EKG Examples
A-Fib with LBBB

Chest X Ray

Echocardiography

Holter Monitoring and Exercise Stress Testing

Cardiac MRI

Treatment

Rate and Rhythm Control

Cardioversion

Overview
Electrical Cardioversion
Pharmacological Cardioversion

Anticoagulation

Overview
Warfarin
Converting from or to Warfarin
Converting from or to Parenteral Anticoagulants
Dabigatran

Maintenance of Sinus Rhythm

Surgery

Catheter Ablation
AV Nodal Ablation
Surgical Ablation
Cardiac Surgery

Specific Patient Groups

Primary Prevention

Secondary Prevention

Supportive Trial Data

Cost-Effectiveness of Therapy

Case Studies

Case #1

Atrial fibrillation pregnancy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Atrial fibrillation pregnancy

CDC on Atrial fibrillation pregnancy

Atrial fibrillation pregnancy in the news

Blogs on Atrial fibrillation pregnancy

Directions to Hospitals Treating Atrial fibrillation pregnancy

Risk calculators and risk factors for Atrial fibrillation pregnancy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.

Synonyms and related keywords: AF, Afib, fib

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]

ACCF/AHA/HRS 2011 Guidelines- Pregnancy (DO NOT EDIT) [7][8]

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. 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. (Level of Evidence: B)

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. (Level of Evidence: C)

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. 7.0 7.1 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
  8. 8.0 8.1 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
  9. 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

de:Vorhofflimmern it:Fibrillazione atriale nl:Boezemfibrilleren no:Atrieflimmer fi:Eteisvärinä


Template:WikiDoc Sources