Palpitations & Atrial FibrillationDr Mehul B Dhinoja, Consultant Cardiologist & ElectrophysiologistBMI The London Independent Hospital

v

Palpitations

Situations

Beginning

During

Ending

Duration

Frequency

Other symptoms

Family history

v

Gold standard for diagnosis

v

Which recording method?

24 hour Holter

48 hour Holter

72 hour Holter

7 day Holter

Event recorder

Loop recorder

12 lead ECG

•Symptom frequency

•Information required

v

Other investigations

Thyroid function

Cardiac MRI

Cardiac CT

Cardiac catheter

Cardiac biopsy

Provocation testing

Echocardiogram

Genetic testing

v

Example

v

Consequences of AF

v

Treatment goals in AF

European Society of Cardiology, 2010

v

Risk stratification

European Society of Cardiology, 2010

≥ 2

v

Stroke prevention

Anticoagulation

Warfarin

Novel Oral Anticoagulants

Unsuitable

Left Atrial Appendage Occlusion

CHADS-VASC ≥2 Dabigatran

Rivaroxaban

Apixaban

v

Rate control

LV function

Tachy-BradySyndrome

Biventricular Pacemaker

AV nodal Ablation

Good

Impaired

Beta Blockers

Calcium Blockers

±Digoxin

Beta Blockers

±Digoxin

Tachy-BradySyndrome

HF Drugs

Single Chamber Pacemaker

ICD Indication?

Review medications

v

Rhythm control

ImpairedLV function ±

Coronary disease

Recurrent symptomatic AF

AF ablation

No

Yes

Flecainide

Sotalol

(Dronedarone)(Sotalol)

HF Drugs

Disopyramide/Propafenone

(Dronedarone)

(Amiodarone)

DC cardioversion

v

Underlying conditions

Atrial fibrillation

Heart failureCardiomyopathies

Inherited arrhythmias

Vascular Disease

Obstructive SleepApnoea

Diabetes Mellitus

Hypertension

Thyrotoxicosis

None

v

Prognosis after AF ablation

Hunter et al, 2011

v

Prognosis after AF ablation

Hunter et al, 2011