Tuesday, October 20, 2020

Unstable AF & Ablation Complications

emDOCs Podcast – Episode 14 - October 20, 2020 - By Long B & singh M
"Today on the emDocs cast with Brit Long and Manpreet Singh we cover two posts: unstable atrial fibrillation patient and cardiac ablation complications.
  • Key Points from the Podcast and Post (Part 1: Unstable Atrial Fibrillation)
    • Don’t prematurely assume that the hypotension in your patient with a-fib is due to the arrhythmia. Do a thorough evaluation for other causes of shock before lowering the rate.
    • When cardioverting your unstable patient with a-fib, do it right the first time; start out at 200J and consider adding external pressure to the anterior pad.
    • Use push dose vasopressors or a drip to stabilize the BP before trying to control the rate.
    • Consider Amiodarone or Esmolol as the drug of choice for rate control in the crashing patient with a-fib.
  • Key Points from the Podcast and Post (Part 2: Cardiac Ablation Complications)
    • The overall complication rate for cardiac ablation is 6.29%.
    • Atrio-esophageal fistula has up to a 100% mortality without surgery. If considered, emergently consult cardiothoracic surgery.
    • EGD may cause fatal massive air embolism in the setting of atrio-esophageal fistula. Avoid even in the case of gross hematemesis.
    • Delayed cardiac tamponade may occur even up to several weeks out from the ablation.
    • Stroke due to thromboembolic event.
    • Atypical migraine is a rare post ablation complication and should be considered a diagnosis of exclusion."