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Published byDominick Pitts Modified over 8 years ago
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Palpitations & Atrial Fibrillation Dr Mehul B Dhinoja, Consultant Cardiologist & Electrophysiologist BMI The London Independent Hospital
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v Palpitations Situations Beginning During Ending Duration Frequency Other symptoms Family history
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v Gold standard for diagnosis
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v Which recording method? 24 hour Holter 48 hour Holter 72 hour Holter 7 day Holter Event recorder Loop recorder 12 lead ECG Symptom frequency Information required
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v Other investigations Thyroid function Cardiac MRI Cardiac CT Cardiac catheter Cardiac biopsy Provocation testing Echocardiogram Genetic testing
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v Example
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v Consequences of AF
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v Treatment goals in AF European Society of Cardiology, 2010
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v Risk stratification European Society of Cardiology, 2010 ≥ 2
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v Stroke prevention Anticoagulation Warfarin Novel Oral Anticoagulants Unsuitable Left Atrial Appendage Occlusion CHADS-VASC ≥2 Dabigatran Rivaroxaban Apixaban
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v Rate control LV function Tachy-Brady Syndrome Biventricular Pacemaker AV nodal Ablation Good Impaired Beta Blockers Calcium Blockers ±Digoxin Beta Blockers ±Digoxin Tachy-Brady Syndrome HF Drugs Single Chamber Pacemaker ICD Indication? Review medications
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v Rhythm control Impaired LV function ± Coronary disease Recurrent symptomatic AF AF ablation No Yes Flecainide Sotalol (Dronedarone) (Sotalol) HF Drugs Disopyramide/Propafenone (Dronedarone) (Amiodarone) DC cardioversion
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v Underlying conditions Atrial fibrillation Heart failure Cardiomyopathies Inherited arrhythmias Vascular Disease Obstructive Sleep Apnoea Diabetes Mellitus Hypertension Thyrotoxicosis None
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v Prognosis after AF ablation Hunter et al, 2011
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v Prognosis after AF ablation Hunter et al, 2011
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