25
Table 18. Hypertrophic Cardiomyopathy
Recommendations COR LOE
Anticoagulation is indicated in patients with HCM with AF
independent of the CHA
2
DS
2
-VASc score.
I B
Antiarrhythmic medications can be useful to prevent
recurrent AF in patients with HCM. Amiodarone
or disopyramide combined with a beta blocker or
nondihydropyridine calcium channel antagonists are
reasonable therapies.
IIa C
AF catheter ablation can be beneficial in patients with
HCM in whom a rhythm-control strateg y is desired when
antiarrhythmic drugs fail or are not tolerated.
IIa B
Sotalol, dofetilide, and dronedarone may be considered for a
rhythm-control strateg y in patients with HCM.
IIb C
Table 19. AF Complicating ACS
Recommendations COR LOE
Urgent direct-current cardioversion of new-onset AF
in the setting of ACS is recommended for patients with
hemodynamic compromise, ongoing ischemia, or inadequate
rate control.
I C
Intravenous beta blockers are recommended to slow a
RVR to AF in patients with ACS who do not display HF,
hemodynamic instability, or bronchospasm.
I C
For patients with ACS and AF with a CHA
2
DS
2
-VASc score
of ≥2, anticoagulation with warfarin is recommended unless
contraindicated.
I C
Administration of amiodarone or digoxin may be considered
to slow a RVR in patients with ACS and AF associated with
severe LV dysfunction and HF or hemodynamic instability.
IIb C
Administration of nondihydropyridine calcium antagonists
might be considered to slow a RVR in patients with ACS and
AF only in the absence of significant HF or hemodynamic
instability.
IIb C
Table 20. Hyperthyroidism
Recommendations COR LOE
Beta blockers are recommended to control ventricular rate
in patients with AF complicating thyrotoxicosis unless
contraindicated.
I C
In circumstances in which a beta blocker cannot be used,
a nondihydropyridine calcium channel antagonist is
recommended to control the ventricular rate.
I C
