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

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3. 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 95-100 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 95-100 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?

4. 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

5. Copyright © 2014 2006 publication: Circulation and J Am Coll Cardiology August 15, 2006 Online www.acc.org

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

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

8. 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

9. 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

10. 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

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