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Answer:
Dear Patient, There many reasons for increased heart rate at night, and it can be normal in some situations. The first step in finding the cause is to determine if this is a normal or abnormal rhythm, by getting an event monitor.
Answer:
Yes - alcohol is a common AF trigger. It is hard to know if yours was temporally related, but many patients feel that alcohol can trigger AF (even hours later).
Answer:
You should definitely see an electrophysiologist to get an opinion. There are many options, depending on how long your AF has been \"persistent.\" Probably starting with a cardioversion and anti-arrhythmic drug such as dofetilide makes sense, to see how much better you feel in normal rhythm. If you feel better then ablation is an option. Standard catheter ablation may be fine, depending on how long you have had AF and how enlarged your atrium is. Near Maryland I can suggest the following: Timm Dickfield at Univ of Maryland, Hugh Calkins or Ron Berger at Johns Hopkins, Frank Marchlinski, Matt Hutchinson or Sanjay Dixit at Penn. Good luck. Let me know if I can be of further help.
Answer:
Star AF2 was just recently published in NEJM and confirmed several smaller studies. I know of no follow-up planned yet. In all honesty the ablation approach for persistent AF depends on the center and electrophysiologist. I do believe the STAR AF2 results and mainly focus on wide astral PVI, ablation of any induced macro reentrant flutters, and ablation of nonPV triggers for persistent AF. I don\'t believe empiric linear or CFAE ablation has a role any more (or ever did), but others may feel differently. Flecainide is an anti arrhythmic medication used to treat AF - it can be used in many situations if you have no coronary artery disease.
Answer:
None. These medications are used for anxiety, and if this is a trigger for your AF it may help. But they are not useful for treating AF, in general.
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