Q. A69-year-old women complains of intermittent palpitations,lasting several hours, which then stop spontaneously. She also suffers from asthma. Holter monitoring confirms paroxysmal atrial fibrillation. Which of the following statement is correct regarding the management of this patient? A. Digoxin effectively prevents recurrence of of the arrhythmia. B. Anticoagulant not necessary. C. Sotalol may be effective. D. Amiodirone should be avoided. E. Flecanide orally may be an effective as-needed treatment to abort an attack.
The correct answer is E. Oral flecainide (E) is now widely recommended to avoid continuous therapy. Propafenone is used in a similar way. Digoxin (A) is not effective in this situation; sotalol (C) may be used but should be avoided because of this patient’s asthma. Amiodarone (D) is effective, but has numerous serious adverse reactions including pulmonary fibrosis, liver damage,peripheral neuropathy and abnormal thyroid function. Anticoagulation (B) is very important to prevent strokes, although in low-risk patients aspirin may be adequate. In patients where drug therapy is ineffective or poorly tolerated, ablation therapy can have a high success rate.
