ISHNE AF World-Wide Internet Symposium II / 2007
  CME Testing

1) What is the most common reason to control the ventricular rate in atrial fibrillation?
1.0) Don't know.
1.A) to reduce symptoms
1.B) to prevent myocardial ischemia
1.C) to decrease the risk of thromboembolism
1.D) to prevent sudden death
1.E) to prevent tachycardia induced cardiomyopathy

2) In the AFFIRM trial, how did rate control with digoxin fare compared to beta-blockers?
2.0) Don't know.
2.A) Rate control with digoxin during exercise was inferior to that with beta-blockers.
2.B) Digoxin was associated with wide swings in heart rate, despite rate control, but this was shown to have no effect on symptoms.
2.C) Compared to beta-blockers, digoxin was less effective to control rate.
2.D) Rate control was achieved faster in the group on digoxin.

3) The oesophagus is juxtaposed to the posterior left atrium in less than 20% of patient.
3.0) Don't know.
3.A) False
3.B) True

4) Oesophageal-atrial fistulae can be avoided during AF ablation by restricting power to 50W and monitoring oesophageal temperatures.
4.0) Don't know.
4.A) False
4.B) True

5) Oesophageal-atrial fistula formation is a delayed complication presenting up to 3 weeks after apparently succesaful AF ablation.
5.0) Don't know.
5.A) False
5.B) True

6) Emergency oesophageal stenting is the procedure of choice when oesophageal-atrial fistula formation is recognized post AF ablation.
6.0) Don't know.
6.A) False
6.B) True

7) Which of the following is NOT a risk factor for ischemic stroke in atrial fibrillation?
7.0) Don't know.
7.A) Hypertension
7.B) Diabetes mellitus
7.C) Male gender
7.D) History of ischemic stroke
7.E) Heart failure

8) Which of the following has NOT been shown to increase the risk of intracerebral hemorrhage?
8.0) Don't know.
8.A) Age
8.B) Prior stroke
8.C) Aspirin
8.D) Hypertension
8.E) Moderate exercise

9) Which of the following has NOT been shown to potentiate the effect of oral vitamin K antagonists?
9.0) Don't know.
9.A) Heart failure
9.B) Amiodarone
9.C) Paracetamol
9.D) Nicotine
9.E) Chemotherapy

10) The following antithrombotic drugs have been shown to reduce all-cause mortality in atrial fibrillation
10.0) Don't know.
10.A) warfarin
10.B) dipyridamole
10.C) clopidogrel
10.D) aspirin
10.E) heparin

11) Which of the following statements is TRUE:
11.0) Don't know.
11.A) aspirin-clopidogrel combination therapy is superior to warfarin in stroke prevention for atrial fibrillation
11.B) adding aspirin to warfarin reduces stroke and myocardial infarction
11.C) bleeding is significantly increased by adding aspirin to warfarin in atrial fibrillation patients
11.D) aspirin-dipyridamole combination therapy is superior to warfarin in stroke prevention for atrial fibrillation
11.E) warfarin is superior to ximelagatran for stroke prevention in atrial fibrillation

12) Which of the following statements on antiplatelet therapy for stroke prevention in atrial fibrillation are TRUE:
12.0) Don't know.
12.A) aspirn 300mg daily is conclusively better than 75mg daily
12.B) aspirin has an addtive effect to warfarin for stroke prevention
12.C) aspirin is recommended for low risk patients in current guidelines
12.D) the magnitude of stroke reduction with aspirin is similar to that seen for antiplatelet therapy use in vascular disease patients
12.E) clopidogrel is established as an effective antiplatelet agent in atrial fibrillation.

13) Which of the following statements on antithrombotic therapy use in atrial fibrillation underging percutaneous coronary intervention (and stenting) are TRUE:
13.0) Don't know.
13.A) evidence based guidelines are available from trials,
13.B) the risk of late stent thrombosis with drug eluting stents in negligible
13.C) aspirin or clopidogrel added to warfarin is recommended chronic therapy in such patients.
13.D) combination triple therapy with aspirin, clopidogrel and warfarin has the lowest bleeding risk
13.E) aspirin plus warfarin is superior to warfarin along post-acute coronary syndrome

14) Which is the most common electrophysiological mechanism of atrial tachycardias occurring after circumferential ablation of atrial fibrillation?
14.0) Don't know.
14.A) Macroreentry
14.B) Automatism
14.C) Nodal reentry
14.D) None of the above

15) In macroreentrant atrial tachycardias the endocavitary atrial activation sequence covers a small interval of the tachycardia cycle length.
15.0) Don't know.
15.A) True
15.B) False

16) 16.The spontaneous remission rate of atrial arrhythmias occurring early after catheter ablation of atrial fibrillation is:
16.0) Don't know.
16.A) less than 15%
16.B) between 70 and 80%
16.C) between 30 and 50%
16.D) More than 80%

17) Which statement is NOT accurate?
17.0) Don't know.
17.A) Vagal stimulation tends to favour macro re-entry.
17.B) Sympathetic influence favours triggered activity.
17.C) It seems to be a primary increase in parasympathetic tone, with a shift towards sympathetic predominance before atrial fibrillation onset.
17.D) Vagal and sympathetic influences may modulate the action potential duration, refractoriness and conduction speed of atrial cells.

18) Ganglionated plexi can NOT be defined
18.0) Don't know.
18.A) at fat pads at different sites of the atria during open chest surgery.
18.B) by three-dimensional endocardial mapping during percutaneous procedures.
18.C) at the locations where stimulation results in ventricular slowing with a > 50% prolongation of the electrocardiographic R-R interval.
18.D) by using high-frequency stimulation (20-50Hz, output 5-15V, pulse width 10 ms).

19) Which statement is correct?
19.0) Don't know.
19.A) Ganlionated plexi are predominantly identified in the pulmonary vein antra.
19.B) Ganlionated plexi have not been identified in non-pulmonary-vein sites.
19.C) Ganlionated plexi are not often identified in the coronary sinus.
19.D) Ganlionated plexi are frequently identified in the inferior caval vein.

20) In analysis of heart rate variability
20.0) Don't know.
20.A) standard deviation of RR (SDRR) intervals, coefficient of variance (COV), the root-mean-square of successive difference (sMSSD) and high frequency power (HF) are known to reflect the activity of the parasympathetic nervous system.
20.B) low frequency (LF) power reflects sympathetic activity.
20.C) LF/HF ratio is interpreted to be a marker of sympathovagal balance.
20.D) an increase in LF/HF ratio suggests vagal withdrawal and increase in sympathetic tone.

21) Which statement on atrial pacing for prevention of atrial fibrillation is correct?
1) Most patients with bradycardia will only respond to dedicated pacing algorithms but not to antibradycardia pacing alone.
2) The ideal atrial pacing site is in the right atrial appendage.
3) A high percentage of ventricular pacing usually increases the success of atrial preventive pacing.
4) A high percentage of atrial pacing is desired to perform overdrive suppression and prevent rate decrease.

21.0) Don't know.
21.A) All are true.
21.B) 1, 2, and 3 are true.
21.C) 3 and 4 are correct.
21.D) Only 4 is correct.
21.E) All are wrong.

22) 22. Which studies showed a deleterious effect of right ventricular pacing on hemodynamics and/or the recurrence of atrial fibrillation?

22.0) Don't know.
22.A) None of these studies.
22.B) Only DAVID
22.C) Only MOST
22.E) All of these studies.

23) What are the indications for atrial pacing for prevention of atrial tachyarrhythmias?
1) It is a typical "stand alone" indication.
2) Patients with sinus node disease of the brady-tachy-type.
3) Patients with drug-induced bradycardia.
4) Patients scheduled for AV node ablation.
5) Patients scheduled for pulmonary vein isolation.

23.0) Don't know.
23.A) All of the above.
23.B) 1-4.
23.C) 2-4.
23.D) Only 2.
23.E) None of the above.

24) Which pacing modes are ideal for pacing to prevent atrial fibrillation?
1) AAI(R)
2) DDD(R) with short AV delay
3) DDD(R) with long AV delay
4) VDD(R)
5) DDD(R) with algorithms to switch to AAI(R) and back
6) VVI(R)

24.0) Don't know.
24.A) All of the above
24.B) 1-5
24.C) 1, 3, 5
24.D) 1 and 2
24.E) None of the above

25) Which right atrial pacing site is presumably ideal for pacing to prevent atrial tachyarrhythmias?
25.0) Don't know.
25.A) Right atrial appendage
25.B) High lateral right atrial wall
25.C) Low lateral right atrial wall
25.D) High atrial septum
25.E) Low anterior right atrial wall

26) What was the incidence of proarrhythmic effects recorded with the use of a class III antiarrhythmic drug nibentan, in a dose of 0.125 mg/kg, for the pharmacological cardioversion of AF episodes?
26.0) Don't know.
26.A) 10%
26.B) 6%
26.C) 3%
26.D) not recorded.

27) Which of the following drugs is highly effective for the pharmacological cardioversion of long lasting (till 1 year) episodes of AF or AFl?
27.0) Don't know.
27.A) ibutilide.
27.B) dofetilide.
27.C) amiodarone.
27.D) nibentan.

28) What average time is required for reversion of AF episodes to sinus rhythm with nibentan?
28.0) Don't know.
28.A) 30 minutes;
28.B) 1 hour;
28.C) 3 hours;
28.D) 12 hours.

29) What effectiveness has nibentan in a dose of 0.125 mg/kg for pharmacological cardioversion of long lasting (till 1 year) persistent AF episodes?
29.0) Don't know.
29.A) not effective;
29.B) 30%;
29.C) 50%;
29.D) 72%.

30) What type of arrhythmia is NOT registered in Figs. 1-3? (see clinical case "Atrial dissociation: Complex dissimilar rhythms included coexistence of atrial flutter, re-entery tachycardia and sinus rhythm"):
30.0) Don't know.
30.A) sinus rhythm
30.B) atrial reentrant tachycardia
30.C) Wolff-Parkinson-White syndrome
30.D) atrial flutter

31) What types of waves are marked with blue arrows in Figs. 1-3? (see clinical case "Atrial dissociation: Complex dissimilar rhythms included coexistence of atrial flutter, re-entery tachycardia and sinus rhythm"):
31.0) Don't know.
31.A) fusion waves
31.B) atrial flutter waves
31.C) sinus P waves
31.D) f-waves of AF

32) Which of the following diagnoses does NOT correspond to the described clinical case?:
32.0) Don't know.
32.A) atrial dissociation
32.B) triple dissimilar rhythm
32.C) atrial flutter, atrial reentrant tachycardia, sinus rhythm
32.D) chaotic atrial rhythm

33) Which of the following conditions is the indication to perform EP study in this patient?:
33.0) Don't know.
33.A) in any case;
33.B) syncope;
33.C) dizziness;
33.D) family history of sudden death

34) The expected incidence of post-operative atrial fibrillation after coronary artery bypass grafting is approximately:
34.0) Don't know.
34.A) 10%
34.B) 30%
34.C) 50%
34.D) 70%

35) Which of the following post-operative complications has not been determined to be more frequent in patients with post-operative atrial fibrillation after cardiac surgery:
35.0) Don't know.
35.B) mortality
35.C) infection
35.D) VT/VF

36) The three therapies with the strongest evidence for efficacy for prevention of post-operative atrial fibrillation after cardiac surgery are
36.0) Don't know.
36.A) standard beta-blockers, atrial pacing, amiodarone
36.B) sotalol, atrial pacing, magnesium
36.C) magnesium, sotalol, atrial pacing
36.D) amiodarone, sotalol, standard beta blockers

37) The prevention of post-operative atrial fibrillation after cardiac surgery with amiodarone has been suggested to reduce:
37.0) Don't know.
37.A) length of post-operative hospital stay
37.B) incidence of TIA/CVA
37.C) incidence of post-operative VT/VF
37.D) all of the above

38) There is strong evidence that successful outcome of AF ablation is related to conduction block and/or delay between the pulmonary veins and the left atrium. True or false?
38.0) Don't know.
38.A) True
38.B) False

39) Which of the following would best be described as a CFAE (complex fractionated atrial electrogram)?
39.0) Don't know.
39.A) A multicomponent electrogram with 4 peaks separated from other electrograms by an isoelectric baseline.
39.B) Discreet, sharp electrograms that have an average cycle length of 150 msec.
39.C) Multicomponent electrograms that are small in amplitude and blend into one another with continuous deflection of the baseline.

40) There is evidence to show that ablation of complex fractionated atrial electrograms in addition to isolation of the pulmonary veins may improve procedural outcome of AF ablation. True or false?
40.0) Don't know.
40.A) True
40.B) False

41) Nurse-clinician centered multi-disciplinary AF Clinics are able to do which of the following?
41.0) Don't know.
41.A) Deliver patient-centered education about AF
41.B) Provide better follow-up of the management plan
41.C) Reduce visits to the emergency department
41.D) Shorten the wait-time for specialist assessment
41.E) All of the above

42) Is there an appropriate unique heart rate target for the definition of "adequate rate control" in atrial fibrillation?
42.0) Don't know.
42.A) True
42.B) False

43) Which of the following is the most appropriate initial rate control therapy for a 42 yr old active male patient with persistent atrial fibrillation, who is engaged in regular intensive physical activity, and has no structural heart disease or other underlying illnesses apart from the atrial fibrillation?
43.0) Don't know.
43.A) Digoxin
43.B) beta blocker
43.C) rate slowing calcium blocker
43.D) either b or c

44) What are the advantages of an atrial-selective sodium channel blocker for the management of atrial fibrillation?
44.0) Don't know.
44.A) Its use is not limited in patients with structural heart disease.
44.B) It can interrupt reentrant arrhythmias by depressing conduction.
44.C) It can suppress triggered activity arising from pulmonary veins.
44.D) All of the above

45) What is the basis for development of atrial-selective potassium channel blockers?
45.0) Don't know.
45.A) Different kinetics of IKr channels in atria and ventricles.
45.B) Presence of ultrarapid delayed rectifier (IKur) channels in atria but not in ventricles.
45.C) A more negative inactivation relationship for the inward rectifier (IK1) in atria vs. ventricles.
45.D) None of the above

46) What is the basis for development of atrial-selective sodium channel blockers?
46.0) Don't know.
46.A) Presence of other than SCN5A sodium channels in atria vs. ventricles
46.B) A more negative steady-state inactivation relationship in atria vs ventricles.
46.C) The presence of a smaller sodium channel current in atria vs. ventricles
46.D) None of the above

47) What is the physiological consequence of inhibiting sodium channels?
47.0) Don't know.
47.A) Slow conduction velocity
47.B) Increase diastolic threshold of excitation
47.C) Induces post-repolarization refractoriness
47.D) All of the above

48) Which of the following acute arrhythmias occurred after secondary procedure of RF ablation was the most frequent:
48.0) Don't know.
48.A) Atrial Fibrillation;
48.B) Atypical Atrial Flutter;
48.C) Atrial tachycardia;
48.D) Atrial premature beats.

49) The percentage of LV filling within 4 days post RF ablation (A.V.Ardashev, 2001):
49.0) Don't know.
49.A) did not change;
49.B) decreased;
49.C) increased;
49.D) increased immediately after ablation.

50) Which of the following expression about changes occurred after RF ablation of AF is FALSE:
50.0) Don't know.
50.A) during the first month improved quality of life;
50.B) during the first month improved myocardial contraction function;
50.C) during the first 12 month significantly decreased SDNN (HR variability marker);
50.D) during the first 24 hs significantly decreased rMSSD (HR variability marker).


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