Today on the emDocs cast with Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER) we cover two posts: unstable atrial fibrillation patient and cardiac ablation complications.
Part 1: Unstable Atrial Fibrillation
Key Points from the Podcast and Post:
-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.
Part 2: Cardiac Ablation Complications
Key Points from the Podcast and Post:
– 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.
