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Atrial Fibrillation Update 2012

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

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  1. Atrial Fibrillation Update 2012 Dr C Seifer Section of Cardiology St Boniface Hospital

  2. 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

  3. Case 1 • LVEF (MUGA) 27% • On metoprolol 100 mg TID and amiodarone 200 mg daily (nausea)

  4. Case 1 • What next?

  5. Case 1 • What next? • Increase/Add medications • No further intervention • Consider pacing and AV node ablation

  6. Case 1 • What next? • Increase/Add medications • No further intervention • Consider pacing and AV node ablation

  7. Case 1 • What next? • Increase/Add medications • No further intervention • Consider pacing and AV node ablation • Anticoagulation?

  8. Can J of Cardiol 2012;28:125-136.

  9. Can J of Cardiol 2012;28:125-136.

  10. 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

  11. Case 2 • Management

  12. Case 2 • Management • Rhythm control? • Rate control?

  13. Case 2 • Management • Rhythm control? • Rate control? • Metoprolol • Diltiazem

  14. 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

  15. Case 3 • What next? • Rhythm control • Rate control

  16. Case 3 • What next? • Rhythm control • D/C cardioversion • ± Antiarrhythmic drugs • Rate control

  17. 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

  18. Case 4 • What next?

  19. Case 4 • What next? • Another drug trial • No change in management • Pacemaker and AV node ablation • Ablation (PVI)

  20. Case 4 • What next? • Another drug trial • No change in management • Pacemaker and AV node ablation • Ablation (PVI)

  21. Can J of Cardiol 2012;28:125-136.

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