Arrhythmias and Conduction Disorders (2026 IMCU)

Educational Objectives for a Lecture on Management of Cardiac Arrhythmias and Conduction Disorders Based on the 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation and the 2022 ESC Guidelines for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death, these objectives are tailored for medical students, residents, or practicing clinicians. 

By the end of this lecture, participants will be able to: 

• Describe the pathophysiological mechanisms underlying atrial fibrillation (AF), including electrophysiological abnormalities such as ectopic action potentials from pulmonary veins and reentrant activity due to interstitial fibrosis, and explain how cardiovascular risk factors like obesity contribute to increased AF risk. 
• Identify the top 10 take-home messages from the 2023 AF guidelines, such as viewing AF as a disease continuum requiring prevention strategies, lifestyle modifications, and early rhythm control to minimize AF burden and adverse outcomes. 
• Apply risk stratification tools, including the CHA2DS2-VASc score and consideration of stroke risk modifiers (e.g., blood pressure control), to determine annual thromboembolic event risk in patients with AF and guide anticoagulation decisions for those at intermediate to low risk (<2%). 
• Evaluate the Class 1 recommendations for catheter ablation in AF management, including its use as first-line therapy in selected patients and in those with heart failure with reduced ejection fraction, citing evidence from randomized studies demonstrating superiority over drug therapy. 
• Recommend updated strategies for device-detected AF in patients with implantable devices or wearables, considering episode duration and underlying thromboembolic risk to provide prescriptive anticoagulation guidance. 
• Analyze the upgraded Class 2a recommendation for left atrial appendage (LAA) occlusion devices in patients with long-term contraindications to anticoagulation, incorporating safety and efficacy data to balance stroke prevention with bleeding risks. 
• Develop management plans for AF identified during medical illness, surgery, or other precipitants, emphasizing the risk of recurrent AF and post-illness monitoring to prevent complications. 
• Compare recommendations for rhythm monitoring tools (e.g., wearable devices) and risk-based selection of oral anticoagulation, balancing benefits and risks in specific populations such as those with AF complicating acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI). 
• Differentiate between periprocedural anticoagulation management strategies for patients with AF undergoing procedures, including when to interrupt or continue therapy based on bleeding and thrombotic risks. 
• Summarize key aspects of long-term rate control in AF using beta blockers or non-dihydropyridine calcium channel blockers, and outline prevention strategies for ventricular arrhythmias and sudden cardiac death from the 2022 ESC guidelines, focusing on patient management in high-risk groups.