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Clinical Management of Atrial Fibrillation

Course #90824 - $60 -

10
  • Participation Instructions
    • Review the course material online or in print.
    • Complete the course evaluation.
    • Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.
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Overview

Atrial fibrillation is one of the most common arrhythmias encountered in clinical practice today. Current treatment options for atrial fibrillation include pharmacological cardioversion, direct current electric cardioversion, radiofrequency ablation, and long-term rate control with a wide variety of oral antiarrhythmic medications. The specific treatment(s) selected to manage atrial fibrillation in adult patients must be tailored to each individual's needs, clinical symptoms, and response to any previous treatment. The efficacy, safety, and cost of the treatment option must also be evaluated. This course will review current treatment options for the clinical management of atrial fibrillation, including indications for use, risks, and criteria for evaluating the treatment's efficacy. Recommendations from the American Heart Association and Agency for Healthcare Research and Practice will be reviewed. Finally, the clinical management of a patient with acute onset atrial fibrillation and a patient with chronic atrial fibrillation will be explored in depth through the use of simulated case studies.

Education Category: Medical / Surgical
Release Date: 11/01/2023
Expiration Date: 10/31/2026

Table of Contents

  1. INTRODUCTION
  2. A BRIEF REVIEW OF NORMAL ELECTRICAL CONDUCTION
  3. A REVIEW OF ELECTROCARDIOGRAM WAVEFORM
  4. ATRIAL FIBRILLATION
  5. ASSESSMENT OF THE PATIENT WITH ATRIAL FIBRILLATION
  6. ESTABLISHING THE MEDICAL PLAN OF CARE
  7. PHARMACOLOGIC THERAPY
  8. PHARMACOLOGIC THERAPY FOR RATE CONTROL
  9. PHARMACOLOGIC CARDIOVERSION
  10. ELECTRICAL CARDIOVERSION
  11. PHARMACOLOGIC THERAPY FOR MAINTENANCE OF NORMAL SINUS RHYTHM
  12. PREVENTION OF THROMBOEMBOLIC COMPLICATIONS
  13. RADIOFREQUENCY ABLATION AND CRYOABLATION IN THE MANAGEMENT OF ATRIAL FIBRILLATION
  14. MANAGEMENT OF ATRIAL FIBRILLATION FOLLOWING CORONARY ARTERY BYPASS GRAFT SURGERY
  15. ATRIAL FIBRILLATION IN WOLFF-PARKINSON-WHITE SYNDROME
  16. SIMULATED CASE STUDY: THE PATIENT WITH ACUTE-ONSET ATRIAL FIBRILLATION
  17. SIMULATED CASE STUDY: CLINICAL MANAGEMENT OF THE PATIENT WITH PERSISTENT ATRIAL FIBRILLATION
  18. CONCLUSION
  19. RESOURCES
  20. Works Cited
  21. Evidence-Based Practice Recommendations Citations

Audience

This course is designed for physicians, physician assistants, nurses, and other healthcare professionals working in an adult healthcare setting, where they are likely to encounter patients who are (or should be) receiving medical intervention for control of atrial fibrillation.

Accreditations & Approvals

In support of improving patient care, TRC Healthcare/NetCE is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. NetCE is approved by the California Nursing Home Administrator Program as a provider of continuing education. Provider number 1622. NetCE is approved to offer continuing education through the Florida Board of Nursing Home Administrators, Provider #50-2405. NetCE is accredited by the International Accreditors for Continuing Education and Training (IACET). NetCE complies with the ANSI/IACET Standard, which is recognized internationally as a standard of excellence in instructional practices. As a result of this accreditation, NetCE is authorized to issue the IACET CEU.

Designations of Credit

This activity was planned by and for the healthcare team, and learners will receive 10 Interprofessional Continuing Education (IPCE) credit(s) for learning and change. NetCE designates this enduring material for a maximum of 10 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. NetCE designates this continuing education activity for 10 ANCC contact hour(s). NetCE designates this continuing education activity for 6 pharmacotherapeutic/pharmacology contact hour(s). NetCE designates this continuing education activity for 12 hours for Alabama nurses. Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 10 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Completion of this course constitutes permission to share the completion data with ACCME. Successful completion of this CME activity, which includes participation in the evaluation component, enables the learner to earn credit toward the CME and/or Self-Assessment requirements of the American Board of Surgery's Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit. This activity has been approved for the American Board of Anesthesiology’s® (ABA) requirements for Part II: Lifelong Learning and Self-Assessment of the American Board of Anesthesiology’s (ABA) redesigned Maintenance of Certification in Anesthesiology Program® (MOCA®), known as MOCA 2.0®. Please consult the ABA website, www.theABA.org, for a list of all MOCA 2.0 requirements. Maintenance of Certification in Anesthesiology Program® and MOCA® are registered certification marks of the American Board of Anesthesiology®. MOCA 2.0® is a trademark of the American Board of Anesthesiology®. Through an agreement between the Accreditation Council for Continuing Medical Education and the Royal College of Physicians and Surgeons of Canada, medical practitioners participating in the Royal College MOC Program may record completion of accredited activities registered under the ACCME's "CME in Support of MOC" program in Section 3 of the Royal College's MOC Program. This home study course is approved by the Florida Board of Nursing Home Administrators for 10 credit hour(s). This course is approved by the California Nursing Home Administrator Program for 10 hour(s) of continuing education credit - NHAP#1622010‐8956/P. California NHAs may only obtain a maximum of 10 hours per course. AACN Synergy CERP Category A. NetCE is authorized by IACET to offer 1 CEU(s) for this program.

Individual State Nursing Approvals

In addition to states that accept ANCC, NetCE is approved as a provider of continuing education in nursing by: Alabama, Provider #ABNP0353, (valid through July 29,2025); Alabama, Provider #ABNP0353, (valid through July 29, 2025); Arkansas, Provider #50-2405; California, BRN Provider #CEP9784; California, LVN Provider #V10662; California, PT Provider #V10842; District of Columbia, Provider #50-2405; Florida, Provider #50-2405; Georgia, Provider #50-2405; Kentucky, Provider #7-0054 through 12/31/2025; South Carolina, Provider #50-2405; South Carolina, Provider #50-2405. West Virginia RN and APRN, Provider #50-2405.

Special Approvals

This activity is designed to comply with the requirements of California Assembly Bill 1195, Cultural and Linguistic Competency.

Course Objective

The purpose of this course is to provide a basic review of current treatment options for the management of atrial fibrillation and indications for use, risks, and criteria for evaluating the treatment's efficacy.

Learning Objectives

Upon completion of this course, you should be able to:

  1. Describe cardiac conduction and the components of an ECG waveform.
  2. Use your knowledge of the pathophysiology of atrial fibrillation, including key defining characteristics, to differentiate it from other arrhythmias and predict impact on normal functioning.
  3. Outline common cardiac and noncardiac causes of atrial fibrillation.
  4. List key clinical data, including subjective symptoms, past medical history, physical assessment findings, and diagnostic/laboratory tests, important to obtain when assessing a patient with atrial fibrillation.
  5. Identify key components that should be considered in the development of the medical plan of care, including the issue of generic drug substitution.
  6. Compare and contrast antiarrhythmic medications appropriate to use for acute and chronic rate control for patients with atrial fibrillation.
  7. Outline the use of pharmacologic therapy in the restoration of normal sinus rhythm, including indications for use and procedure for administration.
  8. Describe electrical cardioversion, including indications and pre- and postprocedure care.
  9. Discuss antiarrhythmic medications that may be used to maintain normal sinus rhythm in a patient following successful spontaneous, electrical, or pharmacologic cardioversion.
  10. Select appropriate pharmacologic measures that may be used to reduce risk of thromboembolic events in persons with atrial fibrillation.
  11. Discuss the use of radiofrequency ablation of the atrioventricular (AV) node in the clinical management of atrial fibrillation.
  12. Describe the causes and recommended management of atrial fibrillation in adult patients following coronary artery bypass graft surgery and in patients with Wolff-Parkinson-White syndrome.
  13. Using simulated case study data, develop a best practice strategy for the clinical management of atrial fibrillation.

Faculty

Karen Majorowicz, RN, is currently employed in the Cardiac Intermediate Care Unit at Shands Healthcare at the University of Florida, Gainesville. She received her Master's in Medical-Surgical Nursing in 1978 from the University of Maryland. Karen has created numerous instructional manuals on Medicare and has conducted educational programs on cardiovascular assessment.

Faculty Disclosure

Contributing faculty, Karen Majorowicz, RN, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.

Division Planners

John M. Leonard, MD

Mary Franks, MSN, APRN, FNP-C

Division Planners Disclosure

The division planners have disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.

Director of Development and Academic Affairs

Sarah Campbell

Director Disclosure Statement

The Director of Development and Academic Affairs has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.

About the Sponsor

The purpose of NetCE is to provide challenging curricula to assist healthcare professionals to raise their levels of expertise while fulfilling their continuing education requirements, thereby improving the quality of healthcare.

Our contributing faculty members have taken care to ensure that the information and recommendations are accurate and compatible with the standards generally accepted at the time of publication. The publisher disclaims any liability, loss or damage incurred as a consequence, directly or indirectly, of the use and application of any of the contents. Participants are cautioned about the potential risk of using limited knowledge when integrating new techniques into practice.

Disclosure Statement

It is the policy of NetCE not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners.

Technical Requirements

Supported browsers for Windows include Microsoft Internet Explorer 9.0 and up, Mozilla Firefox 3.0 and up, Opera 9.0 and up, and Google Chrome. Supported browsers for Macintosh include Safari, Mozilla Firefox 3.0 and up, Opera 9.0 and up, and Google Chrome. Other operating systems and browsers that include complete implementations of ECMAScript edition 3 and CSS 2.0 may work, but are not supported. Supported browsers must utilize the TLS encryption protocol v1.1 or v1.2 in order to connect to pages that require a secured HTTPS connection. TLS v1.0 is not supported.

Implicit Bias in Health Care

The role of implicit biases on healthcare outcomes has become a concern, as there is some evidence that implicit biases contribute to health disparities, professionals' attitudes toward and interactions with patients, quality of care, diagnoses, and treatment decisions. This may produce differences in help-seeking, diagnoses, and ultimately treatments and interventions. Implicit biases may also unwittingly produce professional behaviors, attitudes, and interactions that reduce patients' trust and comfort with their provider, leading to earlier termination of visits and/or reduced adherence and follow-up. Disadvantaged groups are marginalized in the healthcare system and vulnerable on multiple levels; health professionals' implicit biases can further exacerbate these existing disadvantages.

Interventions or strategies designed to reduce implicit bias may be categorized as change-based or control-based. Change-based interventions focus on reducing or changing cognitive associations underlying implicit biases. These interventions might include challenging stereotypes. Conversely, control-based interventions involve reducing the effects of the implicit bias on the individual's behaviors. These strategies include increasing awareness of biased thoughts and responses. The two types of interventions are not mutually exclusive and may be used synergistically.