emDOCs Podcast – Episode 14: Unstable Atrial Fibrillation Patient and Cardiac Ablation Complications

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.