Atrial Fibrillation Update 2012 Dr C Seifer Section

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

Case 1 Ø 86 yo female Ø Hypertension and Coronary Artery Disease Ø > 10 year history of persistent (permanent) atrial fibrillation Ø Difficult to rate control Ø Admitted with CHF and atrial fibrillation with ventricular rate 120 -130 bpm

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

Case 1 Ø What next?

Case 1 Ø What next? l l l Increase/Add medications No further intervention Consider pacing and AV node ablation

Case 1 Ø What next? l l l Increase/Add medications No further intervention Consider pacing and AV node ablation Ø Anticoagulation?

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

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

Case 2 Ø 76 yo female 12 hours post hip replacement Ø History of hypertension and DM 2 Ø Symptoms of palpitations Ø HR 140 bpm and BP 140/80 Ø ECG confirms atrial fibrillation

Case 2 Ø Management

Case 2 Ø Management l l Rhythm control? Rate control?

Case 2 Ø Management l l Rhythm control? Rate control? • Metoprolol • Diltiazem

Case 3 48 yo male Ø Attends for physical Ø Denies any significant symptoms but not very active (truck driver) Ø HR 100 bpm irreg BP 130/80 Ø ECG confirms atrial fibrillation Ø Started on ASA and atenolol Ø ECHO: Mildly dilated LA, normal left ventricle Ø

Case 3 Ø What next? l l Rhythm control Rate control

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

Case 4 54 yo healthy male Ø Two episodes of symptomatic atrial fibrillation in the past 1 year Ø No other co-morbidities Ø Started on Metoprolol and Flecainide Ø Two subsequent episodes of AF – one requiring D/C cardioversion Ø Started on amiodarone – hyperthyroid Ø No structural heart disease Ø

Case 4 Ø What next?

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

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