AF Treatment Protocols & Procedures 2 — Questions and Answers
Question 1: Which antiarrhythmic drug is preferred for pharmacological cardioversion of AF in patients with structural heart disease?
- Flecainide
- Propafenone
- Amiodarone (Correct answer)
- Sotalol
Correct answer: Amiodarone
Amiodarone is preferred for cardioversion in structural heart disease because Class IC agents like flecainide and propafenone are contraindicated in that setting.
Question 2: What is the minimum duration of therapeutic anticoagulation required before elective cardioversion when AF onset is unknown or >48 hours?
- 1 week
- 2 weeks
- 3 weeks (Correct answer)
- 4 weeks
Correct answer: 3 weeks
At least 3 weeks of therapeutic anticoagulation prior to cardioversion is required when AF duration is unknown or exceeds 48 hours to minimize thromboembolic risk.
Question 3: During catheter ablation for AF, which vein(s) are the primary target for electrical isolation?
- Superior vena cava
- Pulmonary veins (Correct answer)
- Coronary sinus
- Left subclavian vein
Correct answer: Pulmonary veins
Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation for AF, as ectopic triggers originate predominantly from pulmonary vein ostia.
Question 4: A patient with paroxysmal AF and no structural heart disease is prescribed a 'pill-in-the-pocket' approach. Which medication is appropriate?
- Amiodarone
- Digoxin
- Flecainide (Correct answer)
- Metoprolol
Correct answer: Flecainide
Flecainide (or propafenone) is used as a pill-in-the-pocket strategy for self-termination of AF in patients without structural heart disease.
Question 5: What energy range is typically used for biphasic direct current cardioversion of AF?
- 10–50 J
- 50–100 J
- 100–200 J (Correct answer)
- 300–360 J
Correct answer: 100–200 J
Biphasic cardioversion for AF typically uses 100–200 J as the initial energy level, with escalation if the first shock is unsuccessful.
Question 6: Which procedural complication is most specific to catheter ablation for AF compared to other ablation procedures?
- Complete heart block
- Pulmonary vein stenosis (Correct answer)
- Cardiac tamponade
- Phrenic nerve injury
Correct answer: Pulmonary vein stenosis
Pulmonary vein stenosis is a complication specific to AF ablation caused by scar formation at the PV ostia following radiofrequency energy delivery.
Question 7: Left atrial appendage (LAA) occlusion devices (e.g., Watchman) are indicated as an alternative to long-term anticoagulation primarily for patients who?
- Prefer oral over injectable therapy
- Have non-valvular AF with high bleeding risk (Correct answer)
- Have persistent AF refractory to two antiarrhythmics
- Require rate control only
Correct answer: Have non-valvular AF with high bleeding risk
LAA occlusion is indicated for non-valvular AF patients with elevated stroke risk (CHA₂DS₂-VASc ≥2) who have contraindications or high risk for long-term anticoagulation.
AF Treatment Protocols & Procedures 2
Which antiarrhythmic drug is preferred for pharmacological cardioversion of AF in patients with structural heart disease?