Management of Atrial Fibrillation After an Ablation

A 55-year-old African-American man with history of symptomatic atrial fibrillation (AF), ischemic cardiomyopathy with EF of 45%, hypertension, hyperlipidemia, obesity and hypothyroidism presents for follow-up in clinic. Four weeks ago, he underwent pulmonary vein isolation (PVI) by radio frequency ablation (RFA) for his paroxysmal AF.

He is currently on metoprolol XL 50 mg daily, lisinopril 20 mg daily, aspirin 81 mg daily, rivaroxaban 20 mg daily, levothyroxine 100 mcg daily, and atorvastatin 40 mg daily. He was on amiodarone 200 mg daily prior to his ablation which was discontinued at discharge after his ablation procedure.

He has no symptoms of chest discomfort, palpitations, or dyspnea but continues to report daytime fatigue. EKG shows normal sinus rhythm with borderline LVH.


A febrile, HR 86, BP 142/74, RR 14, weight 302 lbs, height 66 inches.


General: pleasant obese male.

  • HEENT: thick neck (18 inches circumference), otherwise normal.
  • CV: regular rate and rhythm, normal S1 and S2, systolic ejection murmur 1/6 at RUSB. No pericardial rub.
  • RESP: clear to auscultation, no wheezing or rales.
  • ABD: obese abdomen (belt size 48 inches), normal bowel sounds.
  • EXT: well healed femoral vein access site, warm and well perfused, no edema.
  • NEURO: mentation intact, gait normal.

What is the optimal strategy to prevent recurrence of atrial fibrillation?

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