left ventricular systolic/diastolic function.significant occult valvular heart disease (eg mitral or tricuspid regurgitation).the presence of significant mitral stenosis (refer to ‘Anticoagulation for stroke risk’).9 Transthoracic echocardiography for patients with AF sheds light on: The NHFA recommends polysomnography to diagnose sleep apnoea only for patients with symptomatic AF. Box 1 summarises the essential investigations for patients with newly diagnosed AF the treating practitioner may choose to do additional testing for reversible precipitants (eg sepsis) depending on the patient’s clinical features. For example, thyrotoxicosis will continue to drive AF with rapid ventricular response despite appropriate medical therapy. consider anticoagulation for stroke prevention.Īs a first step, it must be ensured that no acute and reversible pathologies are responsible for triggering AF (Table 1, Figure 1) successful implementation of any management strategy in AF is predicated on such factors being identified and addressed.assess and manage ventricular rates while in (and out of) AF.characterise structural heart disease that may be associated with AF.identify underlying risk factors and reversible precipitants (Table 1).Our suggested approach to patients with newly diagnosed AF is to: Incidental AF is typically diagnosed in two main scenarios: 1) detected on non-invasive cardiac testing (eg echocardiography, 24-hour Holter monitoring, ECG) performed for other clinical reasons, and 2) detected via previously inserted cardiac implantable electronic device (CIED) interrogation (eg implantable loop recorders, pacemakers, defibrillators). as an incidental finding in asymptomatic individuals.The NHFA’s AF guidelines recommend opportunistic AF screening in patients aged ≥65 years with either radial pulse palpation followed by a 12-lead electrocardiogram (ECG) or a single-lead handheld ECG. The patient with newly diagnosed atrial fibrillation Type 2 diabetes/impaired glucose tolerance.Risk factors, disease associations and potentially reversible precipitants for atrial fibrillation 8,10 In light of these findings, the National Heart Foundation of Australia’s (NHFA’s) 2018 AF guidelines recommend aerobic exercise and a target body mass index of 27 kg/m 2 in patients with AF. 9 Once AF has been diagnosed, weight loss and aerobic activity have been shown to decrease both the number of AF episodes and symptoms related to AF.
6–8 A number of studies have investigated whether the risk of developing AF can be reduced with exercise the majority suggest that moderate physical activity is beneficial in reducing AF risk. It is important to note that metabolic syndrome and several of its modifiable constituents (abdominal obesity, hypertension, impaired glucose tolerance/type 2 diabetes) are strongly associated with AF. Table 1 lists the most clinically relevant risk factors and disease associations for AF. Risk factors for, and lifestyle management of, atrial fibrillation Given AF’s varying clinical manifestations, the aim of this article is to distil management concepts into practical recommendations that are useful in general practice. 1–3 The prevalence of AF is estimated to be 2–4% in developed countries 1,4 and increases with age, but this only reflects clinically detected AF the true prevalence of AF is suspected to be greater when subclinical or ‘silent’ AF is included. 1,2 AF is independently associated with stroke, heart failure and all-cause death. Atrial fibrillation (AF) is the most common recurrent arrhythmia in adult clinical practice and is associated with significant morbidity and mortality.
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