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Clinical Crossroads | Clinician's Corner

A 60-Year-Old Woman With Atrial Fibrillation

Daniel E. Singer, MD, Discussant
JAMA. 2003;290(16):2182-2189. doi:10.1001/jama.290.16.2182.
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DR REYNOLDS: Mrs B is a 60-year-old retired teacher with atrial fibrillation (AF). She is married and has 2 daughters. She lives near Boston and has commercial health insurance.

In December 2000, Mrs B experienced several self-limited episodes of palpitations and throat tightness. A stress test was negative for anginal symptoms or ischemic electrocardiogram changes at a high workload; a thyroid-stimulating hormone test was within normal limits. In May 2001, she experienced a severe episode of palpitations and was sent to a local emergency department where she was found to be in AF with a moderate ventricular response. She was treated with intravenous diltiazem and spontaneously converted to sinus rhythm. She was referred to a cardiologist, who recommended aspirin and use of a β-blocker as needed to control palpitations. An echocardiogram showed a mildly enlarged left atrium, but was otherwise normal. A Holter monitor showed nonsustained runs of atrial tachycardia, but no AF.

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Figure 1. Prevalence of Atrial Fibrillation by Subject Age and Sex
Graphic Jump Location
Data describe the community-based Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study cohort.3 Error bars represent 95% confidence intervals. Numbers represent the number of men and women with atrial fibrillation in each age category.
Figure 2. Transesophageal Echocardiographic Image of a Thrombus in the Left Atrial Appendage in a Patient With Atrial Fibrillation
Graphic Jump Location
A large multilobulated thrombus located in the left atrial appendage (outlined by arrowheads). Image generously provided by Richard W. Asinger, MD, Hennepin County Medical Center, University of Minnesota, Minneapolis.

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