124
Management
10.11. Hyperthyroidism
COR LOE
Recommendation
1 B-NR 1. In patients with hyperthyroidism and AF who have an
elevated risk of stroke based on a standard clinical risk score,
anticoagulation is recommended until thyroid function has
returned to normal and sinus rhythm can be maintained.
10.12. Pulmonary Disease
COR LOE
Recommendations
2a B-R 1. In patients with AF and COPD, it is reasonable to use
cardioselective beta blockers for rate control of AF, especially
where other indications exist, such as MI and HF.
2a B-NR 2. In patients with pulmonary hypertension with pulmonary
vascular disease (PH
PVD
) and AF or AFL, a rhythm-control
strateg y is reasonable to improve functional status and
potentially prolong survival.
10.13. Pregnancy
COR LOE
Recommendations
1 B-NR 1. In pregnant patients with AF, DCCV is safe to the patient
and fetus and should be performed in the same manner as in
patients who are not pregnant.
2b C-LD 2. In pregnant individuals with structurally normal hearts and
hemodynamically stable AF, pharmacological cardioversion
with agents with history of safe use in pregnancy, such as
intravenous procainamide, may be considered.
2a C-LD 3. In pregnant individuals with AF and without structural heart
disease, antiarrhythmic agents with history of safe use in
pregnancy, such as flecainide and sotalol, are reasonable for
maintenance of sinus rhythm.
2a B-NR 4. In pregnant individuals with persistent AF, rate-control
agents with a record of safety in pregnancy, such as beta
blockers (eg, propranolol or metoprolol) and digoxin, either
alone or in combination with beta blockers, are reasonable as
first-line agents.
2b C-LD 5. Pregnant individuals with AF and elevated risk of stroke may
be considered for anticoagulation with the recognition that
no anticoagulation strateg y is completely safe for both the
mother and fetus, and an SDM discussion should take place
regarding risks to both mother and fetus (see Table 28).
