AF Treatment Options 2 — Questions and Answers
Question 1: Which antiarrhythmic drug is contraindicated in patients with AF and structural heart disease due to increased mortality risk?
- Amiodarone
- Flecainide (Correct answer)
- Dronedarone
- Sotalol
Correct answer: Flecainide
Flecainide is contraindicated in structural heart disease because it can cause proarrhythmia and increased mortality in these patients.
Question 2: What is the recommended INR target range for warfarin anticoagulation in patients with non-valvular AF?
- 1.5–2.0
- 2.0–3.0 (Correct answer)
- 2.5–3.5
- 3.0–4.0
Correct answer: 2.0–3.0
The standard INR target for non-valvular AF on warfarin is 2.0–3.0, balancing stroke prevention against bleeding risk.
Question 3: Which procedure creates linear lesions in the left atrium to block reentrant circuits causing AF?
- AV node ablation
- Pulmonary vein isolation
- Surgical maze procedure (Correct answer)
- His bundle pacing
Correct answer: Surgical maze procedure
The surgical Cox-Maze procedure creates a series of incisions or ablation lines that block the reentrant circuits responsible for AF.
Question 4: A patient with AF and CrCl of 15 mL/min requires anticoagulation. Which agent is most appropriate?
- Rivaroxaban
- Apixaban
- Dabigatran
- Warfarin (Correct answer)
Correct answer: Warfarin
Warfarin is preferred in severe renal impairment (CrCl <15 mL/min or dialysis) because DOACs are renally cleared and lack sufficient safety data in this population.
Question 5: Catheter ablation for AF primarily targets which anatomical structures to achieve pulmonary vein isolation?
- Tricuspid valve annulus
- Pulmonary vein ostia (Correct answer)
- Coronary sinus
- Crista terminalis
Correct answer: Pulmonary vein ostia
Pulmonary vein isolation targets the ostia of the pulmonary veins, which are the dominant source of ectopic triggers initiating AF.
Question 6: Which beta-blocker is specifically approved for rate control in AF and also reduces hospitalizations in heart failure with reduced ejection fraction?
- Atenolol
- Metoprolol succinate (Correct answer)
- Propranolol
- Labetalol
Correct answer: Metoprolol succinate
Metoprolol succinate (extended-release) is approved for both heart failure with reduced EF and rate control in AF, reducing hospitalizations and mortality.
Question 7: In a patient with AF and Wolff-Parkinson-White syndrome, which drug is contraindicated because it can accelerate conduction through the accessory pathway?
- Propafenone
- Procainamide
- Digoxin (Correct answer)
- Flecainide
Correct answer: Digoxin
Digoxin (and other AV nodal blockers like verapamil and adenosine) are contraindicated in WPW with AF because they block the AV node, forcing more conduction through the accessory pathway and potentially causing ventricular fibrillation.
AF Treatment Options 2
Which antiarrhythmic drug is contraindicated in patients with AF and structural heart disease due to increased mortality risk?