Question 381 · LEK · Atrial fibrillation
A 66-year-old male who has been treated only for hypertension and had no previous diagnosis of atrial fibrillation, checked into emergency dept. because he had heart palpitations for the last 3 days. The patient was haemodynamically stable. ECG showed atrial fibrillation, with ventricle rate of ca. 135/min. Under these conditions, apart from initiating the anticoagulation treatment, you should:
- A. stop atrial fibrillation by electrical cardioversion, regardless of arrhythmia duration, due to high HR.
- B. stop atrial fibrillation by pharmacotherapy, regardless of arrhythmia duration, due to high HR, and if ineffective, perform electrical cardioversion.
- C. slow down HR to the safe and well-tolerated level, without breaking arrhythmia.
- D. slow down HR to the safe and well-tolerated level only after excluding the presence of thrombi in the heart chambers through transoesophageal echocardiography.
- E. refer the patient to cardiology dept. for urgent ablation, in view of no previous diagnosis of atrial fibrillation and the high efficacy of ablation procedure when performed shortly after the onset of arrhythmia before it becomes persistent.
Hint
The arrhythmia has lasted about 3 days and the patient is stable: what must precede any attempt to restore sinus rhythm?
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