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Management of atrial fibrillation
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Patterns of Atrial Fibrillation
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Management of Atrial Fibrillation 1.Anticoagulation 2.Rate control strategy 3.Rhythm control strategy 4.Miscellaneous conditions
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Anticoagulation
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Primary prevention Secondary prevention
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CHA 2 DS 2 - VAS c *Lip GY, Frison L, Halperin JL, Lane DA. Identifying patients at high risk for stroke despite anticoagulation: a comparison of contemporary stroke risk stratification schemes in an anticoagulated atrial fibrillation cohort. Stroke. 2010;41(12):2731-8.
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Primary Prevention
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Yes Stroke prevention in atrial fibrillation
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Recommendations for stroke prevention in patients with atrial fibrillation
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Rivaroxaban (ROCKET-AF) Apixaban (ARISTOTLE) Edoxaban (ENGAGE AF-TIMI 48) Dabigatran (RE-LY) Recommendations for stroke prevention in patients with atrial fibrillation
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Secondary Prevention
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Initiation or continuation of anticoagulation after ischaemic stroke or transient ischaemic attack
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Secondary stroke prevention
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Initiation or continuation of anticoagulation after Intracranial hemorrhage
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Recommendations for occlusion or exclusion of the left atrial appendage
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Rate control strategy
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Acute heart rate control Long term heart rate control
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Rhythm control strategy
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Acute rhythm control Long term rhythm control Further management in case of fail therapy
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Acute rhythm control
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Long term rhythm control
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Rhythm control
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Further management in case of fail therapy
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Catheter ablation of atrial fibrillation and atrial fibrillation surgery
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Complication of catheter ablation
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Miscellaneous
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Inherited Cardiomyopathies
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During Pregnancy
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Congenital Heart defects
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Atrial fibrillation and Heart failure
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Valvular heart disease and Atrial fibrillation
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Atrial fibrillation and Respiratory disease
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Active Bleeding
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Anticoagulant after ACS
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Anticoagulant after elective PCI
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Use oral anticoagulation in all AF patients unless they are at low risk for stroke based on the CHA2DS2VASc score or have true contraindications for anticoagulant therapy Reduce all modifiable bleeding risk factors in all AF patients on oral anticoagulation Check ventricular rate in all AF patients and use rate control medications to achieve lenient rate contro Evaluate AF-related symptoms in all AF patients using the modified EHRA symptoms scale. Whenever patients have AF- related symptoms, aim to improve symptoms by adjustment of rate control therapy and by offering antiarrhythmic drugs, cardioversion, or catheter or surgical ablation Summary
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Select antiarrhythmic drugs based on their safety profile and consider catheter or surgical ablation when antiarrhythmic drugs fail Do not use antiplatelet therapy for stroke prevention in AF Do not permanently discontinue oral anticoagulation in AF patients at increased risk of stroke unless such a decision is taken by a multidisciplinary team Do not use rhythm control therapy in asymptomatic AF patients, nor in patients with permanent AF Do not perform cardioversion or catheter ablation without anticoagulation, unless an atrial thrombus has been ruled out by transoesophageal echocardiogram
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