Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for follow-up of long-standing persistent atrial fibrillation (AF >12 months). Reports ongoing symptoms of [palpitations/fatigue/dyspnea on exertion/reduced exercise tolerance]. Denies syncope, chest pain, or orthopnea. Current rhythm control strategy: [rate control/rhythm control/ablation]. Adherence to anticoagulation is [confirmed/suboptimal].
Clinical Examination Findings
Cardiovascular: Irregularly irregular heart rhythm, pulse deficit present. S1 and S2 audible, no murmurs, rubs, or gallops. JVP is [normal/elevated]. Peripheral pulses are [symmetric/diminished]. No peripheral edema. Lungs: Clear to auscultation bilaterally, no crackles or wheezing.
Treatment Protocol
1. Anticoagulation: Continue [DOAC/Warfarin] for stroke prophylaxis (CHA2DS2-VASc score: [X]). 2. Rate Control: Continue [Beta-blocker/CCB/Digoxin] to maintain resting HR <80-110 bpm. 3. Rhythm Strategy: [Continue current rhythm control/Consider cardioversion/Refer for PVI ablation/Rate control only]. 4. Monitoring: Periodic ECG and Holter monitoring as indicated.