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Atrial Fibrillation Update 2012. Dr C Seifer Section of Cardiology St Boniface Hospital. Case 1. 86 yo female Hypertension and Coronary Artery Disease > 10 year history of persistent (permanent) atrial fibrillation Difficult to rate control
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Atrial Fibrillation Update 2012 Dr C Seifer Section of Cardiology St Boniface Hospital
Case 1 • 86 yo female • Hypertension and Coronary Artery Disease • > 10 year history of persistent (permanent) atrial fibrillation • Difficult to rate control • Admitted with CHF and atrial fibrillation with ventricular rate 120-130 bpm
Case 1 • LVEF (MUGA) 27% • On metoprolol 100 mg TID and amiodarone 200 mg daily (nausea)
Case 1 • What next?
Case 1 • What next? • Increase/Add medications • No further intervention • Consider pacing and AV node ablation
Case 1 • What next? • Increase/Add medications • No further intervention • Consider pacing and AV node ablation
Case 1 • What next? • Increase/Add medications • No further intervention • Consider pacing and AV node ablation • Anticoagulation?
Case 2 • 76 yo female 12 hours post hip replacement • History of hypertension and DM2 • Symptoms of palpitations • HR 140 bpm and BP 140/80 • ECG confirms atrial fibrillation
Case 2 • Management
Case 2 • Management • Rhythm control? • Rate control?
Case 2 • Management • Rhythm control? • Rate control? • Metoprolol • Diltiazem
Case 3 • 48 yo male • Attends for physical • Denies any significant symptoms symptoms but not very active (truck driver) • HR 100 bpmirregirreg BP 130/80 • ECG confirms atrial fibrillation • Started on ASA and atenolol • ECHO: Mildly dilated LA, normal left ventricle
Case 3 • What next? • Rhythm control • Rate control
Case 3 • What next? • Rhythm control • D/C cardioversion • ± Antiarrhythmic drugs • Rate control
Case 4 • 54 yo healthy male • Two episodes of symptomatic atrial fibrillation in the past 1 year • No other co-morbidities • Started on Metoprolol and Flecainide • Two subsequent episodes of AF – one requiring D/C cardioversion • Started on amiodarone – hyperthyroid • No structural heart disease
Case 4 • What next?
Case 4 • What next? • Another drug trial • No change in management • Pacemaker and AV node ablation • Ablation (PVI)
Case 4 • What next? • Another drug trial • No change in management • Pacemaker and AV node ablation • Ablation (PVI)