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