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Primary Care

Cardiac Electrophysiology   

Questions discussed in this category

What is your approach to maintenance of sotalol in terms of drug monitoring and duration of therapy for outpatients who remain in normal sinus rhythm?
3 Answers available
With the rise in home monitoring devices, how should we approach asymptomatic NSVT detected in healthy individuals with no prior cardiac history and with low risk cardiac profile?
1 Answer available
Should systemic anticoagulation be considered for patients with a less than 1% atrial fibrillation burden on outpatient monitoring with an elevated CHADSVASc score and acceptable bleeding risk?
2 Answers available
Is a history of coronary artery disease and afib a contraindication to using donepezil?
How do you counsel patients about any potential risk?
1 Answer available
What is the minimum duration of weeks on anticoagulation in which you would consider performing a DCCV without the need for TEE, provided the patient is an excellent historian and otherwise reliable?
3 Answers available
For elderly patients (i.e. older than 80) with only one documented episode of paroxysmal atrial fibrillation following a stress event (such as acute illness/steroid administration) and a CHADsVASc score greater than 1, how would you counsel them on the risks/benefits of anticoagulation and subsequent monitoring for afib recurrence?
1 Answer available
What EKG findings are most concerning when screening asymptomatic athletes in the outpatient setting?
4 Answers available
Would you consider lifelong versus short-term (i.e. several months) course of anticoagulation for patients with elevated CHADSVASc score presenting with newly diagnosed paroxysmal atrial fibrillation triggered in the setting of acute illness (i.e. tachyarrhythmias with COVID-19 or bacterial pneumonia)?
2 Answers available
What is your outpatient approach to monitoring paroxysmal atrial fibrillation (i.e. mobile cardiac telemetry, decision to anticoagulate if high likelihood of recurrence) in young adults with CHADsVASC score of 0, in light of potential remodeling and increased Afib burden as they age?
1 Answer available
Can sotalol initiation for atrial fibrillation be performed safely outpatient, and if so, what would be a reasonable protocol for implementing this? 
Can sotalol initiation for atrial fibrillation be performed safely outpatient, and if so, what would be a reasonable approach to accomplishing this?&n...
1 Answer available
In male patients in their 60s who had a single episode of PAF (24 hours, terminated spontaneously or with beta-blockers) without recurrence on 30-day monitoring, and without reversible triggers (such as OSA), should lifelong anticoagulation be started when they turn 65, thereby, increasing the CHA2DS2 VASc score to 1?
1 Answer available
What patient population is most likely to benefit from pill in pocket strategy for management of paroxysmal atrial fibrillation in an unmonitored setting?
Do you have a preference on type of adjunct AV nodal blocker to use, and do propafenone and flecainide have similar safety profiles? 
1 Answer available
What continuous duration of device defined atrial fibrillation burden warrants initiation of anticoagulation if the patient qualifies by CHA2DS2-vasc score?
2 Answers available
In people who have had a single detected episode of atrial fibrillation, but none documented subsequently, is there any consideration for increased thrombolembolic risk just from altered atrial architecture, impaired contractility?
1 Answer available
Can bleeding risk when switching from VKA treatment to a NOAC in frail, elderly patients be accurately compared if individual times in therapeutic range while on VKA treatment are not captured?
Individual times in the therapeutic range while on VKA treatment was not registered in FRAIL-AF.
2 Answers available
How do you advise patients with paroxysmal atrial fibrillation regarding their caffeine consumption, given that a randomized clinical trial found no association between caffeine intake and the triggering of AF episodes?
Marcus et al., PMID 34775507
1 Answer available
How frequently should outpatient mobile cardiac telemetry be ordered following resolution of post-CABG-related atrial fibrillation for patients off anticoagulation?
1 Answer available
Do you think that home INR monitoring is a feasible option for elderly, frail patients with atrial fibrillation on VKA treatment, given variations in socioeconomic status and access to care?
2 Answers available
What is a reasonable amount of ventricular arrhythmia burden on outpatient remote monitoring that would prompt consideration for VT ablation in patients with normal LV function and mild symptoms? 
1 Answer available
What is your outpatient approach to patients with new-onset paroxysmal atrial fibrillation in the setting of acute illness but who are otherwise asymptomatic with normal sinus rhythm post-hospital discharge?
Specifically, what is your approach to outpatient monitoring to assess atrial fibrillation burden for patients with CHADS2Vasc score>2?
2 Answers available
What percentage of patients with non-sustained focal atrial tachycardia detected on an outpatient Holter develop paroxysmal atrial fibrillation, and how should we identify and treat patients at the highest risk of progressing to PAF?
2 Answers available
When would you consider discharging post-TAVR patients on outpatient mobile cardiac telemetry with baseline right bundle branch block without further signs of conduction abnormalities 24-48 hours after the procedure, given risk of developing later-onset conduction abnormalities?
And if so, what is a reasonable length of time for outpatient cardiac monitoring?
2 Answers available
What is a reasonable atrial fibrillation percentage burden that would benefit from systemic anticoagulation for a patient with an elevated CHA₂DS₂-VASc score?
2 Answers available


Papers discussed in this category

JACC Cardiovasc Interv, 2017 Jul 19
Clinical Impact of Baseline Right Bundle Branch Block in Patients Undergoing Transcatheter Aortic Valve Replacement.
Struct Heart, 2022 Mar 17
Risk Stratification and Management of Advanced Conduction Disturbances Following TAVI in Patients With Pre-Existing RBBB.
J Am Coll Cardiol, 2019 Aug 27
Management of Conduction Disturbances Associated With Transcatheter Aortic Valve Replacement: JACC Scientific Expert Panel.
Circulation, 2011-08-09
Interpretation of the electrocardiogram of young athletes.
British journal of sports medicine, 2017-05
International criteria for electrocardiographic interpretation in athletes: Consensus statement.
European heart journal, 2017-05-01
Duration of device-detected subclinical atrial fibrillation and occurrence of stroke in ASSERT.
Circulation, 2018-01-16
Treatment of Subclinical Atrial Fibrillation: Does One Plus One Always Equal Two?
N Engl J Med, 2012 Jan 12
Subclinical atrial fibrillation and the risk of stroke.
JAMA, 2001-05-09
Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study.
The American journal of cardiology, 2015-12-15
Frequent Atrial Premature Complexes and Their Association With Risk of Atrial Fibrillation.
Journal of electrocardiology, 2018
Frequent premature atrial complexes as a predictor of atrial fibrillation: Systematic review and meta-analysis.
Lancet, 2021 Aug 27
Implantable loop recorder detection of atrial fibrillation to prevent stroke (The LOOP Study): a randomised controlled trial.
American heart journal, 2017 Apr 24
Rationale and design of the Apixaban for the Reduction of Thrombo-Embolism in Patients With Device-Detected Sub-Clinical Atrial Fibrillation (ARTESiA) trial.
The New England journal of medicine, 2023 Aug 25
Anticoagulation with Edoxaban in Patients with Atrial High-Rate Episodes.
Journal of the American College of Cardiology, 1998-07
Is hospital admission for initiation of antiarrhythmic therapy with sotalol for atrial arrhythmias required? Yield of in-hospital monitoring and prediction of risk for significant arrhythmia complications.
Journal of the American College of Cardiology, 1992-03-15
Role of prophylactic anticoagulation for direct current cardioversion in patients with atrial fibrillation or atrial flutter.
Archives of internal medicine, 1995-07-10
Prevention of embolic events after cardioversion of atrial fibrillation. Current and evolving strategies.
The New England journal of medicine, 2001-05-10
Use of transesophageal echocardiography to guide cardioversion in patients with atrial fibrillation.
Cerebrovascular diseases extra, 2017
In Potential Stroke Patients on Warfarin, the International Normalized Ratio Predicts Ischemia.
N Engl J Med, 2019 Mar 18
Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation.
The American journal of cardiology, 2009 Dec 01
Increasing prevalence of atrial fibrillation and flutter in the United States.
Circulation, 2023 Nov 30
2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
Clinical medicine (London, England), 2017 Oct
Cardioverting acute atrial fibrillation and the risk of thromboembolism: not all patients are created equal .
Journal of the American Heart Association, 2023 Jun 10
Identifying Patients at High Risk of Left Atrial Appendage Thrombus Before Cardioversion: The CLOTS-AF Score.
Journal of the American Heart Association, 2021 Aug 13
Early Risk of Stroke in Patients Undergoing Acute Versus Elective Cardioversion for Atrial Fibrillation.

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