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AF is generally classified into three types, pregnant seks this may require further investigations and cardiologist input to determine. Knowing the type helps to guide treatment decisions regarding rate or rhythm control. Rate or pregnant seks control. The choice between rate or pregnant seks control is guided by the type of AF and other factors such as age, the presence of co-morbidities, the presence or absence of symptoms and patient preference.

Clinical trials have not shown any significant differences between rate or rhythm pregnat with respect to rates of stroke and mortality. Improvements in quality of life are seen with both treatment approaches.

Rhythm control, which aims to restore and maintain sinus rhythm, should be considered for patients with:4,7All patients for whom a rhythm control strategy is contemplated should be referred to a pregnant seks. Rate control medicines The ventricular rate may be controlled using beta pregnant seks, rate limiting calcium channel blockers (verapamil or diltiazem) or digoxin. The choice of a medicine for rate control in patients in primary care should be guided by the presence of co-morbidities and also by the level of activity of the patient.

Table 1 lists first to fourth-line options for rate control. Medicines may be used singularly or in pregnant seks. A patient who is pregnant seks is unlikely to achieve prehnant control swks digoxin alone.

Patients who achieve poor pregnant seks control on maximally tolerated first, second or third-line medicines used in combination, particularly with ongoing symptoms, should be referred to a cardiologist for consideration of additional treatment options.

This may include amiodarone, AF ablation or AV node ablation with pacemaker implantation. Consultation with a cardiologist pregnant seks also recommended if there is any uncertainty over which combinations of medicines to use. Rhythm Control All patients, for whom rhythm control is considered to be pregnant seks most appropriate treatment option, should be referred to a cardiologist.

Sinus rhythm can be restored using electrical or pharmacological cardioversion, e. AF may pregnant seks after electrical or pharmacological cardioversion therefore ongoing rhythm control with pregnant seks medicines will usually be required. Pregnanf is associated with a pro-thrombotic state and an approximately five-fold increase in stroke risk.

The risk pregnant seks stroke is the same regardless of whether the patient has paroxysmal or sustained (permanent or persistent) AF.

Bleeding risk should be estimated to help assess the risk-benefit ratio prior to choosing appropriate antithrombotic treatment. If a patient has a CHADS2 score of less than 2, consider using CHA2DS2-VASc to further evaluate risk and to guide treatment choice. Aspirin may be considered for patients with AF who are unsuitable for anticoagulation. Also consider co-morbidities, monitoring requirements and patient preference when determining pregnant seks anticoagulation is suitable.

Once the decision to anticoagulate has been made, the next decision is whether to use warfarin or dabigatran. All patients with haemodynamically significant valvular disease or a prosthetic valve should be anticoagulated with warfarin. There are a number of guidelines deks for the management weks AF.

The pregnant seks New Zealand guideline and the 2006 United Kingdom NICE guidelines are scheduled for review. Thank you pregnant seks Dr Gerry Devlin, Cardiologist and Clinical Unit Leader Cardiology, Cardiac Surgery and Thoracovascular Surgery, Waikato DHB for expert guidance in developing this article. Login to my bpac. Cardiovascular systemHaematology 0 Management of atrial fibrillation in pregnant seks practice Atrial fibrillation (AF) is often an incidental finding during a routine medical assessment.

In this article What is atrial fibrillation. In a younger patient with recurrent episodes of very symptomatic AF and a clear onset of symptoms, the preference is cstb rhythm control.

If sperm tube cannot be performed within 48 hours, the patient must be anticoagulated to facilitate this at pregnant seks later date. Medicines such as metoprolol can be used to control the rate and relieve symptoms. Referral to secondary care is required for cardioversion whether pharmacological or electrical and also for advice about ongoing rhythm control.

Acknowledgement Thank you to Dr Gerry Devlin, Cardiologist and Clinical Unit Leader Cardiology, Cardiac Surgery and Thoracovascular Pregnant seks, Waikato DHB for expert guidance in pregnaht this article. References Kannel W, Wolf P, Benjamin E, Levy D. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. Heeringa J, van der Kuip D, Hofman A, et al.

Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Wolf P, Abbott R, Kannel W. Atrial fibrillation as an independent risk factor for stroke: the Framingham study. National Institute for Health and Clinical Excellence (NICE). Camm A, Kirchhof P, Lip G, et al.



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