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Palpitations & Atrial Fibrillation

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

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  1. Palpitations & Atrial Fibrillation Dr Mehul B Dhinoja, Consultant Cardiologist & Electrophysiologist BMI The London Independent Hospital

  2. Palpitations Situations Duration Beginning Frequency During Other symptoms Ending Family history

  3. Gold standard for diagnosis

  4. 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

  5. Other investigations Echocardiogram Cardiac biopsy Thyroid function Provocation testing Cardiac MRI Genetic testing Cardiac CT Cardiac catheter

  6. Example

  7. Consequences of AF

  8. Treatment goals in AF European Society of Cardiology, 2010

  9. Risk stratification ≥ 2 European Society of Cardiology, 2010

  10. Stroke prevention CHADS-VASC ≥2 Dabigatran Rivaroxaban Anticoagulation Novel Oral Anticoagulants Apixaban Warfarin Unsuitable Left Atrial Appendage Occlusion

  11. 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?

  12. 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

  13. Underlying conditions Obstructive Sleep Apnoea Heart failure Cardiomyopathies Diabetes Mellitus Inherited arrhythmias Atrial fibrillation Thyrotoxicosis Vascular Disease None Hypertension

  14. Prognosis after AF ablation Hunter et al, 2011

  15. Prognosis after AF ablation Hunter et al, 2011

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