Management of Atrial Fibrillation in a 37-Year-Old Female Patient With Severe Asthma

A 37-year-old female with severe asthma was referred for additional management of palpitations and occasional syncopal spells. Her records include an electrocardiogram (ECG) with sinus rhythm and a first-degree atrioventricular (AV) block (PR interval 260 ms). An auto-triggered 30-day event monitor shows repeated episodes of atrial fibrillation (AF) that correlate with her symptoms. Her echocardiogram demonstrates a structurally normal heart.

Her syncopal spells have never lead to any serious injury, and in the past she has had a positive tilt table test with reproduction of syncope.

In discussing management strategy with her, she asks, “what is the best way to keep me in sinus rhythm for a long time?”

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