disease interaction(s) of atrial fibrillation with mitral stenosis

Introduction

Interactions:

• high risk of thromboembolic events
• anticoagulation indicated
  • heparin at onset
  • long-term warfarin (coumadin)
• pharmacologic control of ventricular rate
  • digoxin
  • verapamil 5-10 mg IV, then 80 mg PO TID
  • beta-blocker
• cardioversion
  • synchronized DC cardioversion if hemodynamically compromised
    • hypotension
    • pulmonary edema
    • angina
  • attempt to restore sinus rhythm indicated except in presence of marked left atrial enlargement
  • elective attempts at chemical or electrical cardioversion should be preceded by anticoagulation for 3 weeks to minimize risk of thromboembolic event after restoration of sinus rhythm
  • chemical cardioversion with type Ia anti-arrhythmic agent
    • quinidine
    • procainamide
  • synchronized DC cardioversion if chemical cardioversion fails
  • continue type Ia anti-arrhythmic agent after successful cardioversion to maintain sinus rhythm
• radiofrequency ablation if mitral valve surgery

More general terms

• disease interaction