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Paroxysmal Atrial Fibrillation: How to Safely Restore Sinus Rhythm?

Paroxysmal Atrial Fibrillation: How to Safely Restore Sinus Rhythm?

A 52-year-old man you have followed for several years presents to your clinic complaining of palpitations of 2 weeks’ duration. ECG findings reveal that he is in atrial fibrillation (AF) (ventricular rate, 124 beats/min). He does not take any medications and you prescribe an oral beta-blocker for his symptoms. At a follow-up visit 4 weeks later, he is still in AF (ventricular rate, 82 beats/min). The patient reports ongoing poor exercise tolerance and dyspnea on exertion. You determine that a rhythm strategy is appropriate and refer him for electrocardioversion.
 
How can the cardioversion be safely accomplished in this patient?

A. The patient can proceed directly to cardioversion without anticoagulation, since his CHADS2
and CHADS2-VASC scores = 0.

B. The patient can proceed directly to cardioversion without anticoagulation, since his CHADS2 and CHADS2-VASC scores = 0; after the procedure he should begin and continue warfarin for 4 weeks

C. Cardioversion can be done (without transesophageal echocardiogram) after 4 weeks of warfarin therapy with documented INRs in the therapeutic range (2-3); warfarin should be continued for 4 weeks afterwards

D. None of the above

Please make a selection, then click here for the answer and discussion.

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