7. Disease
        Cardiovascular
Atrial fibrillation

Atrial fibrillation

A. Presentation

Palpitation (rapid irregular rhythm)

Weakness, faint, breathlessness

May present with signs and symptoms of systemic embolism

 

B. Investigation

ECG

 

Rule out other causes

C. Treatment

Anticoagulation therapy

Use heparin (short term) or warfarin (for long term)

When using warfarin, target INR range = 2~3

 

If the patient has sustained non-valvular AF but without any of the following risk factors

     ---> Use aspirin instead of warfarin/heparin (reduced benefit but much reduced risk of side effect)

 

Conversion therapy

Anticoagulation therapy with heparin or warfarin should start before elective cardioversion (unless AF is <24 hours in duration)

 

Pharmacological cardioversion

Sotalol (?III, also a beta-blocker) OR

Fecainide (Ic) OR

Amiodarone (III)

 

If drug conversion fails, try synchronized electrical cardioversion.

 

D. Other notes

[epidemilogy/risk factors/
causes/mechanisms/compications/ddx/
classification/staging/
followups/prognosis/prognostic factors/prevention]

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Created20031025
Updated20031025


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