Post-CABG AF with Haemodynamic Compromise — FRCA Final MCQ

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ModerateCardiothoracic AnaesthesiaPost-CABG AF with Haemodynamic CompromiseFRCA Final

A 58-year-old man (ASA III) with coronary artery disease is on the ICU post-CABG. He develops new atrial fibrillation with a ventricular rate of 148 bpm and BP 85/55. He is haemodynamically unstable. What is the first-line treatment?

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Correct answer: A — Synchronised DC cardioversion

New atrial fibrillation with haemodynamic instability (hypotension, poor perfusion) in any setting requires synchronised DC cardioversion as first-line treatment. Start at 120-150J biphasic. This is recommended by the Resuscitation Council UK peri-arrest tachycardia algorithm. Amiodarone is first-line for pharmacological cardioversion in post-cardiac surgery AF when the patient is stable. Rate control with beta-blockers or amiodarone is appropriate only when haemodynamically stable.

Reference: Resuscitation Council UK – 2021 – Peri-arrest tachycardia algorithm; NICE – 2021 – NG196 Atrial fibrillation