Anticoagulation should be immediately considered if your CHADS 2 or CHADS 2 Vasc score is 2 or higher. If no symptoms, then additional treatment is elective. If this is typical atrial flutter, there is a high cure rate with ablation as a first line therapy, though up to 50% of patients will also develop atrial fibrillation.
Many patients with diabetes are at risk for atrial fibrillation and atrial flutter. Other associated conditions include sleep apnea, obesity and metabolic syndrome.
The following medications are essential in heart failure- beta blocker (metoprolol, carvedilol), ACE inhibitor (lisinopril), possibly spironolactone, and some diuretic therapy (lasix). After this, if the heart function remains depressed, then a defibrillator should be considered which can prolong your life. Additionally if you have a left bundle branch block, a BiV-ICD (with resynchronization pacing) would be of great benefit.
First I would want to know that there was a true correlation between the finger monitor and a Holter or ECG of the HR jump to 180-200. That sounds like an artifact and inaccurate measurement of the rate. If real, there are some patients with arrhythmia triggered by cough, it is usually a variant of SVT.
Atrial fibrillation is essentially always progressive. The patterns of recurrence can change with changes in associated triggers like worsening obesity, sleep apnea, high stress, uncontrolled hypertension, and increased alcohol intake. Additionally, though a history of AF has been present for many years, diseases like hyper or hypothyroidism should be considered.
Amlodipine doesn\'t have any direct effect of congestive heart failure. It decreases BP and positively affect HTN which in turn can help patients with CHF. His new onset HF needs to be evaluated. Rule out CAD or intermittent episodes of silent AF that is rapid which could cause tachycardia induced cardiomyopathy. I am sure his cardiologist is working him through for these issues. You can discuss about the work up with him during his next visit. Make sure he is appropriately anticoagulated since he is asymptomatic his overall AF burden could be underestimated and perhaps under treated.
AF is a chronic disease. If you developed AF once the likelihood of you developing AF again is high. Watch for symptoms and get checked periodically. the simplest thing you can do is to check your pulse and make sure it is not rapid or irregular.
Your risk factor profile needs to be appropriately addressed - BP control/diabetes/ sleep apnea/ weight/ alcohol intake etc needs to be taken care of.
Looks like you have reached a point where Ablation seems to be the next thing to do.
Based on your question I did not get which country you are in. Bordeaux is a great place where a lot of good work gets done. Follow up is critically important. You need a good center where you have easy access to the doc and subsequently if you need a redo. If Bordeaux fits that profile then you should definitely consider that. If not then try to find a good center around you.
Please email me at dlakkireddy at kumc.edu with further questions
I am a little bit confused about your supine hypertension that is brought on by antihypertensive therapy. the details of your case are incomplete for me to make any recommendations.
Please see a cardiologist or an electrophysiologist locally
Dr. Andrea Natale
Dr. Andrea Natale is a board certified electrophysiology expert and practices at executive medical director of the Texas Cardiac Arrhythmia Institute at St. David's Medical Center in Austin, Texas. Dr. Natale also is the Senior Medical Director at Pacific Atrial Fib and Arrhythmia Center in San Francisco. He visits MetroHealth in Cleveland, and Akron General, Ohio. He has pioneered a new circumferential ultrasound vein-ablation system to correct atrial fibrillation and performed the procedure on the world's first five patients. For further details Please visit :Link
Dr. Dhanunjaya Lakkireddy
Dr. Dhanunjaya Lakkireddy, MD, F.A.C.C, FHRS. is a board certified electrophysiology expert and practices at Mid-America Cardiology and The University of Kansas Hospital Clinics in Kansas City, KS, USA. He has several distinctions in clinical and research career to his credit and serves as an associate editor for Journal of Atrial Fibrillation.For further details Please visit :Link
Dr. Dhanunjay Lakkireddy, MD, F.A.C.C, FHRS, The Kansas City Heart Rhythm Institute (KCHRI), KS, USA.
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