Atrial Fibrillation: NCLEX Priorities
AFib for NCLEX: rate vs rhythm control, anticoagulation, CHA2DS2-VASc, cardioversion considerations.
AFib is the most common sustained arrhythmia. NCLEX tests rate control vs rhythm control, anticoagulation, and stroke risk.
Recognition
Irregularly irregular pulse. ECG: no P waves, irregular R-R, variable QRS.
Rate control
Beta-blocker (metoprolol) or non-DHP CCB (diltiazem, verapamil). Digoxin in HF. Target HR <110 (lenient) or <80 (strict).
Rhythm control
Antiarrhythmic (amiodarone, flecainide, dronedarone). Cardioversion (electrical or chemical). Catheter ablation.
Anticoagulation
CHA2DS2-VASc scoring: ≥2 (men), ≥3 (women) → anticoagulate. DOAC (apixaban, rivaroxaban) first-line in non-valvular AFib. Warfarin for valvular.
Cardioversion safety
If AFib >48h, need 3+ weeks anticoagulation before cardioversion OR TEE to rule out atrial clot. Otherwise stroke risk from clot dislodgement.
Frequently asked
Patient with paroxysmal AFib, anticoagulate?
Yes if CHA2DS2-VASc indicates. Paroxysmal carries same stroke risk as persistent.
Holter for asymptomatic patient?
If suspected silent AFib. Increasing role for wearables (Apple Watch detected).
Quick check
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