Management of atrial fibrillation

I am a GP in London. I was interested in your statement saying that
all AF patients in the UK have a transthoracic ECHO done as a routine. I
would say that this is not the case within UK primary care and i note that
the UK NICE guidelines June 2006 state that a transthroacic ECHO is not
used as an investigation in all AF patients, but reserved for those

· for whom a baseline echocardiogram is important for long-
term management, such as younger patients

· for whom a rhythm-control strategy that includes
cardioversion (electrical or pharmacological) is being considered

· in whom there is a high risk or a suspicion of underlying
structural/functional heart disease (such as heart failure or heart
murmur) that influences their subsequent management (for example, choice
of antiarrhythmic drug)

in whom refinement of clinical risk stratification for antithrombotic
therapy is needed

I welcome your comments

regards

Dr Raj Nair

MB BS BSc (Hons) MRCGP (Distc)

DCH DRCOG DFFP

GP Principal Albion Street Group Practice

Programme Director St Thomas' GP VTS Scheme

GPwSI COPD

Competing interests:
None declared