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Atrial Fibrillation is one of the most common ED presentations. Currently it affects about 1% of the population and is expected to increase by FIVE FOLD in the coming years as more of the population ages.

When it causes symptoms, it can be debilitating for those with it. More importantly, it is associated with a 30% stroke risk.

Firstly define the type of fibrillator your patient is:

INITIAL – first episode of AF.
PAROXYSMAL – Self terminating, usually in 48 hours, but may last up to 7 days.
PERSISTENT – Lasts more than 7 days.
PERMANENT – Only rate control is considered.

Who is suited to RHYTHM control?
– younger patients
– those in paroxysmal AF
– no functional heart disease
– AF due to precipitants (cardiac/non-cardiac)
– significant symptoms

Who is suited to RATE control?
– persistent/permanent AF
– minimal symptoms
– elderly >65years old
– structural heart disease
– coronary artery disease

Peter Kas

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