Atrial Fibrillation: How Controlled is Well Controlled? COPYRIGHT © 2014, ALL RIGHTS RESERVED From the Publishers of

Copyright © 2014 Terms of Use The Consult Guys ® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the Consult Guys ® slide sets constitutes copyright infringement.

Copyright © 2014 Dear “C” Guys; Need your help to get my hospital Chief Medical Officer off my back. I have a patient in the hospital who is recovering from orthopedic surgery. He has chronic afib and receives warfarin and beta blocker to control his atrial fibrillation ventricular response. He has no history of coronary artery disease and left ventricular function is normal. His hip replacement surgery went well. He is receiving beta blocker and the ortho guys even let me restart his warfarin. His atrial fibrillation ventricular response is bpm. I was always told that the optimal afib ventricular response is approximately 80 bpm. I think that he should remain in the hospital another day to allow me to better control the afib. The CMO says if that is the only reason for hospitalization that he should leave now. What do you guys think? Dear “C” Guys; Need your help to get my hospital Chief Medical Officer off my back. I have a patient in the hospital who is recovering from orthopedic surgery. He has chronic afib and receives warfarin and beta blocker to control his atrial fibrillation ventricular response. He has no history of coronary artery disease and left ventricular function is normal. His hip replacement surgery went well. He is receiving beta blocker and the ortho guys even let me restart his warfarin. His atrial fibrillation ventricular response is bpm. I was always told that the optimal afib ventricular response is approximately 80 bpm. I think that he should remain in the hospital another day to allow me to better control the afib. The CMO says if that is the only reason for hospitalization that he should leave now. What do you guys think?

Copyright © 2014 Is there an “optimal” atrial fibrillation ventricular response following surgery? Is there a benefit to “tight” control of atrial fibrillation ventricular response? A Dispute to Settle

Copyright © publication: Circulation and J Am Coll Cardiology August 15, 2006 Online

Copyright © 2014 ACC / AHA / ESC 2006 Guidelines with focused 2011 update for the Management of Patients With Atrial Fibrillation

Copyright © 2014 Lenient Hr < 110 bpm Strict Rest hr < 80 Mod exerc hr <110

Copyright © 2014 Primary Outcomes Cardiac death CHF Stroke Systemic embolism Major bleed Syncope Sustainable VT Cardiac arrest Life threatening complication of anti-arrhythmic Pacemaker Secondary Outcomes Symptoms

Copyright © 2014 Primary Outcomes Cardiac death CHF Stroke Systemic embolism Major bleed Syncope Sust VT Cardiac arrest Life threat compl of antiarrhythmic Pacemaker Secondary Outcomes Symptoms DISCHARGE

Copyright © 2014 Primary Outcomes Cardiac death CHF Stroke Systemic embolism Major bleed Syncope Sust VT Cardiac arrest Life threat compl of antiarrhythmic Pacemaker Secondary Outcomes Symptoms DISCHARGE CMO WINS

COPYRIGHT © 2014, ALL RIGHTS RESERVED Produced by and