Atrial Fibrillation Course 2: Evaluation and Management

1. Recognize that there are 2 major strategies for treating patients with atrial fibrillation: rate vs rhythm control.
2. Articulate that maintaining sinus rhythm is the goal for most patients with atrial fibrillation
3. Recognize medications that can be used to maintain sinus rhythm as well as potential adverse effects
4. Defend changes in recommendations for evaluation and treatment of AF patients based on specific features in order to optimize care

Access the Course:

Visit the IUSM CEHP Specialized Education website using the link below.

https://medicine.iu.edu/continuing-education/specialized/atrial-fibrillation

American Board of Internal Medicine (ABIM)–MOC Part 2 Credit
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 3.0 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Disclosure Summary
Indiana University School of Medicine (IUSM) policy ensures that those who have influenced the content of a CE activity (e.g. planners, faculty, authors, reviewers and others) disclose all financial relationships with any ineligible companies so that IUSM may identify and mitigate any conflicts of interest prior to the activity. All educational programs sponsored by Indiana University School of Medicine must demonstrate balance, independence, objectivity, and scientific rigor. 

There are no relevant financial relationship(s) with ineligible companies for anyone who was in control of the content of this activity, except: 

Dr. Mithilesh Das has disclosed Consulting Fee from Johnson and Johnson. 
Dr. John Miller has disclosed Fellowship Support Funds; Lecturer from Abbott Electrophysiology, Biosense Webster, Biotronik, Boston Scientific Corporation, and Medtronic. Also, Royalties or Patent Beneficiary from Elsevier and Advisor from Physcade and Vektor Medical. 

All of the relevant financial relationships listed for these individuals have been mitigated. 

An ineligible company is any entity whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. 

References:

Module 1

1. Van Gelder IC, Rienstra M, Crijns HJ, et al.: Rate control in atrial fibrillation. Lancet 388:818-828, 2016.
2. Van Gelder IC, Groenveld HF, Crijns HJ, et al.: Lenient versus strict rate control in patients with atrial fibrillation. N Engl J Med 362:1363-1373, 2010.
3. Joglar JA, Chung MK, Armbruster AL, et al.: 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. J Am Coll Cardiol 2023.
4. Van Gelder IC, Hobbelt AH, Marcos EG, et al.: Tailored treatment strategies: a new approach for modern management of atrial fibrillation. J Intern Med 279:457-466, 2016.
5. Wyse DG, Waldo AL, DiMarco JP, et al.: A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 347:1825-1833, 2002.
6.  Van Gelder IC, Hagens VE, Bosker HA, et al.: A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med 347:1834-1840, 2002.
7. Georgilis, Shenaz MSN, RN, FNP-BC, Byfield, Carlene DNP, RN. Lippincott nursing Center.  September/October 2022, Volume 20 Number     5 , p 24 – 31.  Atrial fibrillation: What nurses need to know | CE Article | NursingCenter
8.  José A. Joglar, MD, FACC, FAHA, FHRSLinks to an external site., et al. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation:   a report of the American heart association joint committee on clinicl practice guidelines.  Circulation Volume 149, Number 1. https://doi.org/10.1161/CIR.0000000000001193
9. Nesheiwat Z, Goyal A, Jagtap M, et al. Atrial Fibrillation (Nursing) [Updated 2023 Apr 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK568719/
10. Al-Khatib SM, LaPointe NMA, Kramer JM, Califf RM. What Clinicians Should Know About the QT Interval. 2003;289(16):2120–2127.  doi:10.1001/jama.289.16.2120
11. Synchronized cardioversion (2024). I Lippincott procedures.  Retrieved from https://procedures.lww.com/lnp/view.do?pId=3724439&hits=cardioversion&a=true&ad=false&q=cardioversion

Module 2

1. Joglar JA, Chung MK, Armbruster AL, et al.: 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. J Am Coll Cardiol 2023.
2. Waks JW, Zimetbaum P: Antiarrhythmic drug therapy for rhythm control in atrial fibrillation. J Cardiovasc Pharmacol Ther 22:3-19, 2017.
3. Kuck KH, Brugada J, Furnkranz A, et al.: Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation. N Engl J Med 374:2235-2245, 2016.
4. Andrade JG, Deyell MW, Macle L, et al.: Progression of Atrial Fibrillation after Cryoablation or Drug Therapy. N Engl J Med 388:105-116, 2023.
5. Kirchhof P, Camm AJ, Goette A, et al.: Early Rhythm-Control Therapy in Patients with Atrial Fibrillation. N Engl J Med 383:1305-1316, 2020.
6. Cardiac ablation pre-post procedure care (2024). I Lippincott procedures.  Retrieved from https://procedures.lww.com/lnp/view.do?pId=3725241&hits=catheter,ablation,catheters,ablates&a=true&ad=false&q=catheter%20ablation

Module 3

1. Joglar JA, Chung MK, Armbruster AL, et al.: 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. J Am Coll Cardiol 2023.
2. Tamirisa KP, Elkayam U, Briller JE, et al.: Arrhythmias in Pregnancy. JACC Clin Electrophysiol 8:120-135, 2022.
3. Sohns C, Fox H, Marrouche NF, et al.: Catheter Ablation in End-Stage Heart Failure with Atrial Fibrillation. N Engl J Med 389:1380-1389, 2023.
4. Giancaterino S, Urey MA, Darden D, et al.: Management of Arrhythmias in Cardiac Amyloidosis. JACC Clin Electrophysiol 6:351-361, 2020.
5. Lin DS, Lo HY, Huang KC, et al.: Efficacy and Safety of Direct Oral Anticoagulants for Stroke Prevention in Older Patients With Atrial Fibrillation: A Network Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc 12:e030380, 2023.
6. Steiner, JM, Jackson, JJ, Ilonze, O, Ross, L, Thachil, R. “Feature | Cardiopsychology: Exploring the Heart/Brain Connection in Cardiovascular Disease” - American College of Cardiology Cardiology Magazine.  May 3 2024. 

Module 4

1. Haïssaguerre M, Jaïs P, Shah DC, et al.: Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 339:659-666, 1998.
2. Chauhan VS, Verma A, Nayyar S, et al.: Focal source and trigger mapping in atrial fibrillation: Randomized controlled trial evaluating a novel adjunctive ablation strategy. Heart Rhythm 17:683-691, 2020.
3. Verma A, Jiang CY, Betts TR, et al.: Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med 372:1812-1822, 2015.
4. Gronberg T, Hartikainen JE, Nuotio I, et al.: Anticoagulation, CHA2DS2VASc Score, and Thromboembolic Risk of Cardioversion of Acute Atrial Fibrillation (from the FinCV Study). Am J Cardiol 117:1294-1298, 2016.
5. Boriani G, Glotzer TV, Santini M, et al.: Device-detected atrial fibrillation and risk for stroke: an analysis of >10,000 patients from the SOS AF project (Stroke preventiOn Strategies based on Atrial Fibrillation information from implanted devices). Eur Heart J 35:508-516, 2014.
6. Healey JS, Lopes RD, Granger CB, et al.: Apixaban for Stroke Prevention in Subclinical Atrial Fibrillation. N Engl J Med 2023.
7. Riley MP, Zado E, Hutchinson MD, et al.: Risk of stroke or transient ischemic attack after atrial fibrillation ablation with oral anticoagulant use guided by ECG monitoring and pulse assessment. J Cardiovasc Electrophysiol 25:591-596, 2014.
8. Verma A, Ha ACT, Kirchhof P, et al.: The Optimal Anti-Coagulation for Enhanced-Risk Patients Post-Catheter Ablation for Atrial Fibrillation (OCEAN) trial. Am Heart J 197:124-132, 2018.
9. Schrickel JW, Linhart M, Bansch D, et al.: Rationale and design of the ODIn-AF Trial: randomized evaluation of the prevention of silent cerebral thromboembolism by oral anticoagulation with dabigatran after pulmonary vein isolation for atrial fibrillation. Clin Res Cardiol 105:95-105, 2016.
10. Raghunath S, Pfeifer JM, Ulloa-Cerna AE, et al.: Deep Neural Networks Can Predict New-Onset Atrial Fibrillation From the 12-Lead ECG and Help Identify Those at Risk of Atrial Fibrillation-Related Stroke. Circulation 143:1287-1298, 2021.
11. Prasitlumkum N, Cheungpasitporn W, Chokesuwattanaskul A, et al.: Diagnostic accuracy of smart gadgets/wearable devices in detecting atrial fibrillation: A systematic review and meta-analysis. Arch Cardiovasc Dis 114:4-16, 2021.
12. Increasing Patient Engagement Through the Use of Wearable Technology. Bove, Lisa Anne, The Journal for Nurse Practitioners, Volume 15, Issue 8, 535-539.

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Mitigation of Relevant Financial Relationships

This activity is supported by an educational grant from Biosense- Webster, Boston Scientific and Bristol Meyers Squibb and Pfizer Alliance