Managing Asymptomatic Early AF in a 55-Year-Old Patient
A 55-year-old female patient was referred to the electrophysiology clinic by her primary cardiologist. She has a history of coronary artery disease, type 2 diabetes mellitus and hypertension, and was recently hospitalized for acute pancreatitis 4 months ago. An electrocardiogram (ECG) performed during admission revealed atrial fibrillation (AF) with controlled ventricular rate. She did not carry a diagnosis of AF prior to this hospitalization and was intermittently in AF during her hospitalization. She was discharged with apixaban after risk/benefit discussions regarding her CHA2DS2-VASc score of 3 with close cardiology follow-up. Today she is feeling well, denied ever having symptoms, and her ECG showed AF. Her medications include aspirin 81 mg daily, lisinopril 20 mg daily, metformin 1000 mg daily, atorvastatin 40 mg daily, and apixaban 5 mg twice daily. Her stress echocardiography performed last year showed no ischemic abnormalities and normal biventricular function.
Which of the following is the best strategy to manage the patient's AF to prevent future cardiovascular adverse events?